Provider Demographics
NPI:1629629811
Name:NGUYEN, THAO
Entity Type:Individual
Prefix:
First Name:THAO
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22819 OAKGROVE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166-4369
Mailing Address - Country:US
Mailing Address - Phone:703-606-7880
Mailing Address - Fax:
Practice Address - Street 1:2260 HUNTERS WOODS PLZ
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-2898
Practice Address - Country:US
Practice Address - Phone:703-860-0300
Practice Address - Fax:703-402-2026
Is Sole Proprietor?:No
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26858183500000X
VA0202218233183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist