Provider Demographics
NPI:1578909495
Name:NGUYEN, MICHAEL J (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
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 1:317 SAGE SPARROW CIR
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-7752
Mailing Address - Country:US
Mailing Address - Phone:707-446-4302
Mailing Address - Fax:
Practice Address - Street 1:317 SAGE SPARROW CIR
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-7752
Practice Address - Country:US
Practice Address - Phone:707-446-4302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-18
Last Update Date:2013-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57947183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist