Provider Demographics
NPI:1578846630
Name:NGUYEN, PHUONG UYEN THUY
Entity Type:Individual
Prefix:MS
First Name:PHUONG UYEN
Middle Name:THUY
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 1:49076 LARKSPUR TER
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-7494
Mailing Address - Country:US
Mailing Address - Phone:510-353-1734
Mailing Address - Fax:
Practice Address - Street 1:342 W CALAVERAS BLVD
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-5242
Practice Address - Country:US
Practice Address - Phone:408-263-3963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH51688183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist