Provider Demographics
NPI:1639485816
Name:NGUYEN, KHOI M (RPH)
Entity Type:Individual
Prefix:
First Name:KHOI
Middle Name:M
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 N IMPERIAL AVE
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-1323
Mailing Address - Country:US
Mailing Address - Phone:760-353-8592
Mailing Address - Fax:760-353-8576
Practice Address - Street 1:2030 N IMPERIAL AVE
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-1323
Practice Address - Country:US
Practice Address - Phone:760-353-8592
Practice Address - Fax:760-353-8576
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA479911835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy