Provider Demographics
NPI:1659352557
Name:NGUYEN, HANH T (PHARMACIST)
Entity Type:Individual
Prefix:MRS
First Name:HANH
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 1:7400 VAN NUYS BLVD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-1966
Mailing Address - Country:US
Mailing Address - Phone:818-988-6191
Mailing Address - Fax:818-988-4311
Practice Address - Street 1:7400 VAN NUYS BLVD
Practice Address - Street 2:SUITE 111
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-1966
Practice Address - Country:US
Practice Address - Phone:818-988-6191
Practice Address - Fax:818-988-4311
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHA4619703336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA461970Medicaid