Provider Demographics
NPI:1639794886
Name:NGUYEN, KHANHBAO (PHARMD)
Entity Type:Individual
Prefix:
First Name:KHANHBAO
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4855 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-5024
Mailing Address - Country:US
Mailing Address - Phone:937-279-0468
Mailing Address - Fax:
Practice Address - Street 1:4855 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-5024
Practice Address - Country:US
Practice Address - Phone:937-279-0468
Practice Address - Fax:937-279-2262
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-13
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH031361343336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy