Provider Demographics
NPI:1558964460
Name:NGUYEN, DUONG T
Entity Type:Individual
Prefix:DR
First Name:DUONG
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 PARISH BLVD
Mailing Address - Street 2:
Mailing Address - City:MARY ESTHER
Mailing Address - State:FL
Mailing Address - Zip Code:32569-3427
Mailing Address - Country:US
Mailing Address - Phone:912-224-7445
Mailing Address - Fax:
Practice Address - Street 1:250 E MIRACLE STRIP PKWY
Practice Address - Street 2:
Practice Address - City:MARY ESTHER
Practice Address - State:FL
Practice Address - Zip Code:32569-1924
Practice Address - Country:US
Practice Address - Phone:850-243-9557
Practice Address - Fax:850-659-3287
Is Sole Proprietor?:No
Enumeration Date:2020-11-21
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS60619183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist