Provider Demographics
NPI:1598137507
Name:THAI, NHAT TAN NGUYEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NHAT TAN
Middle Name:NGUYEN
Last Name:THAI
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 1:1252 N FORMOSA AVE
Mailing Address - Street 2:APT 2
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-5800
Mailing Address - Country:US
Mailing Address - Phone:813-451-4117
Mailing Address - Fax:
Practice Address - Street 1:1252 N FORMOSA AVE
Practice Address - Street 2:APT 2
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-5800
Practice Address - Country:US
Practice Address - Phone:813-451-4117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73732183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist