Provider Demographics
NPI:1629421383
Name:NGUYEN, JACQUELINE T (PHARMACIST)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:T
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 1:3680 S BEAR ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-7280
Mailing Address - Country:US
Mailing Address - Phone:858-776-2566
Mailing Address - Fax:
Practice Address - Street 1:13701 BEACH BLVD STE A2
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-3201
Practice Address - Country:US
Practice Address - Phone:714-373-0214
Practice Address - Fax:714-373-0839
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50255183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist