Provider Demographics
NPI:1619252327
Name:NGUYEN, ANGIE NGOC (PHARM D)
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:NGOC
Last Name:NGUYEN
Suffix:
Gender:F
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 1:205 W SHAW AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-3602
Mailing Address - Country:US
Mailing Address - Phone:559-325-1858
Mailing Address - Fax:559-325-3479
Practice Address - Street 1:205 W SHAW AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-3602
Practice Address - Country:US
Practice Address - Phone:559-325-1858
Practice Address - Fax:559-325-3479
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62161183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist