Provider Demographics
NPI:1659469518
Name:NGUYEN, NAM PHUOC THANH (PHARM D)
Entity Type:Individual
Prefix:
First Name:NAM
Middle Name:PHUOC THANH
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4894 BUCKBOARD WAY
Mailing Address - Street 2:
Mailing Address - City:EL SOBRANTE
Mailing Address - State:CA
Mailing Address - Zip Code:94803-3819
Mailing Address - Country:US
Mailing Address - Phone:510-222-9164
Mailing Address - Fax:707-651-4243
Practice Address - Street 1:975 SERENO DR
Practice Address - Street 2:ONCOLOGY DEPARTMENT - MEDICINE 6
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2441
Practice Address - Country:US
Practice Address - Phone:707-651-2794
Practice Address - Fax:707-651-4243
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA485251835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology