Provider Demographics
NPI:1558684126
Name:NGUYEN, DAN K (RPH)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:K
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 CROSSWAY DR
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-6223
Mailing Address - Country:US
Mailing Address - Phone:634-243-4823
Mailing Address - Fax:
Practice Address - Street 1:341 COMMACK RD
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-3444
Practice Address - Country:US
Practice Address - Phone:631-462-9077
Practice Address - Fax:631-462-1535
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053655183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist