Provider Demographics
NPI:1598435232
Name:NGUYEN, PHUONG HUYNH
Entity Type:Individual
Prefix:
First Name:PHUONG
Middle Name:HUYNH
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 1:3003 DRIFTWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78574-5637
Mailing Address - Country:US
Mailing Address - Phone:956-369-4669
Mailing Address - Fax:
Practice Address - Street 1:5326 E US HIGHWAY 83 STE A5
Practice Address - Street 2:
Practice Address - City:RIO GRANDE CITY
Practice Address - State:TX
Practice Address - Zip Code:78582-9409
Practice Address - Country:US
Practice Address - Phone:956-317-1112
Practice Address - Fax:956-317-1113
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69316183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist