Provider Demographics
NPI:1659654697
Name:NGUYEN, MINH-TAM (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MINH-TAM
Middle Name:
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 1:1329 HIGHWAY 160 W
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-8498
Mailing Address - Country:US
Mailing Address - Phone:803-548-6877
Mailing Address - Fax:803-548-8059
Practice Address - Street 1:1329 HIGHWAY 160 W
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-8498
Practice Address - Country:US
Practice Address - Phone:803-548-6877
Practice Address - Fax:803-548-8059
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC122401835P1200X
NC156401835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy