Provider Demographics
NPI:1568000651
Name:NGUYEN, KATELYN LYBANG (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:LYBANG
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4829 CLAIREMONT DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-2706
Mailing Address - Country:US
Mailing Address - Phone:858-273-5300
Mailing Address - Fax:858-273-5267
Practice Address - Street 1:4829 CLAIREMONT DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-2706
Practice Address - Country:US
Practice Address - Phone:858-273-5300
Practice Address - Fax:858-273-5267
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65993183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist