Provider Demographics
NPI:1659744852
Name:NGUYEN, LUU PHUONG (PHARM D)
Entity Type:Individual
Prefix:
First Name:LUU PHUONG
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
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 1:2559 S KING RD
Mailing Address - Street 2:STE B10
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-1894
Mailing Address - Country:US
Mailing Address - Phone:408-440-2077
Mailing Address - Fax:866-373-0415
Practice Address - Street 1:2559 S KING RD STE B10
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-1894
Practice Address - Country:US
Practice Address - Phone:408-440-2077
Practice Address - Fax:866-373-0415
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-10
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58306183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist