Provider Demographics
NPI:1528598869
Name:NGUYEN, BRENDON (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRENDON
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2491 PACIFIC AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2900
Mailing Address - Country:US
Mailing Address - Phone:562-595-9333
Mailing Address - Fax:562-595-4111
Practice Address - Street 1:2491 PACIFIC AVE STE 1
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2900
Practice Address - Country:US
Practice Address - Phone:562-595-9333
Practice Address - Fax:562-595-9333
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-19
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59939183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist