Provider Demographics
NPI:1619353737
Name:NGUYEN, DUY MINH
Entity Type:Individual
Prefix:
First Name:DUY
Middle Name:MINH
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7117 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73127-5211
Mailing Address - Country:US
Mailing Address - Phone:405-370-4315
Mailing Address - Fax:
Practice Address - Street 1:2345 N CLASSEN BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-5804
Practice Address - Country:US
Practice Address - Phone:405-521-0924
Practice Address - Fax:405-521-0944
Is Sole Proprietor?:No
Enumeration Date:2015-07-31
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15686183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist