Provider Demographics
NPI:1609413707
Name:NGUYEN, DEWEY ANH (PHARMD)
Entity Type:Individual
Prefix:
First Name:DEWEY
Middle Name:ANH
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 1:17130 SAN MATEO ST APT B12
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-3621
Mailing Address - Country:US
Mailing Address - Phone:714-414-5666
Mailing Address - Fax:
Practice Address - Street 1:17130 SAN MATEO ST APT B12
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-3621
Practice Address - Country:US
Practice Address - Phone:714-414-5666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-08
Last Update Date:2019-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81504183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist