Provider Demographics
NPI:1568542397
Name:NGUYEN, PHU MANH (PHARMD)
Entity Type:Individual
Prefix:
First Name:PHU
Middle Name:MANH
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 1:7757 TIGERWOODS DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95829-6607
Mailing Address - Country:US
Mailing Address - Phone:916-688-6774
Mailing Address - Fax:916-688-6110
Practice Address - Street 1:6600 BRUCEVILLE RD
Practice Address - Street 2:MEDICINE D (PHARMACY)
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-4671
Practice Address - Country:US
Practice Address - Phone:916-688-6774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA542691835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology