Provider Demographics
NPI:1609153899
Name:NGUYEN, NGOC THANH (PHARM D)
Entity Type:Individual
Prefix:MS
First Name:NGOC
Middle Name:THANH
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:THANH-NGOC
Other - Middle Name:THI
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3067 S SHERIDAN BLVD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80227-4150
Mailing Address - Country:US
Mailing Address - Phone:720-214-0186
Mailing Address - Fax:720-214-0741
Practice Address - Street 1:3067 S SHERIDAN BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80227-4150
Practice Address - Country:US
Practice Address - Phone:720-214-0186
Practice Address - Fax:720-214-0741
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-15
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17506183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist