Provider Demographics
NPI:1568010965
Name:NGUYEN, NHAN PHUOC (PHARMD)
Entity Type:Individual
Prefix:
First Name:NHAN
Middle Name:PHUOC
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 1:1816 SW 331ST PL
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-6482
Mailing Address - Country:US
Mailing Address - Phone:253-414-4094
Mailing Address - Fax:
Practice Address - Street 1:4000 W 27TH AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99337-2422
Practice Address - Country:US
Practice Address - Phone:509-582-7781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60959917183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist