Provider Demographics
NPI:1619456043
Name:NGUYEN, JAYDE BAONGOC (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:JAYDE
Middle Name:BAONGOC
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 W CERRITOS AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-6028
Mailing Address - Country:US
Mailing Address - Phone:714-478-0779
Mailing Address - Fax:
Practice Address - Street 1:530 WOOLLOMES AVE
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-9581
Practice Address - Country:US
Practice Address - Phone:661-370-4078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78454183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist