Provider Demographics
NPI:1629348958
Name:NGUYEN, TIN HUY (PHARMD)
Entity Type:Individual
Prefix:
First Name:TIN
Middle Name:HUY
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16320 BRIDGELAWN AVE
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-4850
Mailing Address - Country:US
Mailing Address - Phone:813-628-4441
Mailing Address - Fax:813-628-4442
Practice Address - Street 1:7108 CAUSEWAY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-6364
Practice Address - Country:US
Practice Address - Phone:813-628-4441
Practice Address - Fax:813-628-4442
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-03
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36840183500000X
3336C0003X
FLPH25203333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No183500000XPharmacy Service ProvidersPharmacist
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003203900Medicaid