Provider Demographics
NPI:1609417245
Name:NGUYEN, HIEU CHI (PHARMD)
Entity Type:Individual
Prefix:
First Name:HIEU
Middle Name:CHI
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 1:2673 SE BIKAS LN
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7114
Mailing Address - Country:US
Mailing Address - Phone:646-662-4626
Mailing Address - Fax:
Practice Address - Street 1:1954 SW GATLIN BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-2722
Practice Address - Country:US
Practice Address - Phone:772-224-3020
Practice Address - Fax:772-878-9388
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-04
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS54052183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist