Provider Demographics
NPI:1609547561
Name:BUI, PHUONG UYEN NGUYEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:PHUONG UYEN
Middle Name:NGUYEN
Last Name:BUI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3394 AUBURN LEAF LOOP
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-6062
Mailing Address - Country:US
Mailing Address - Phone:408-891-1699
Mailing Address - Fax:
Practice Address - Street 1:526 E BIDWELL ST
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3119
Practice Address - Country:US
Practice Address - Phone:916-984-7749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85159183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA91306549E79259Medicaid