Provider Demographics
NPI:1619237286
Name:NGUYEN, TIEN VAN (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:TIEN
Middle Name:VAN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 MIRA LAGO BLVD
Mailing Address - Street 2:APT. 177
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75234-6079
Mailing Address - Country:US
Mailing Address - Phone:337-251-6169
Mailing Address - Fax:
Practice Address - Street 1:1101 IRA E WOODS AVE
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-4020
Practice Address - Country:US
Practice Address - Phone:817-601-0350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49478183500000X
LA019286183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist