Provider Demographics
NPI:1679867725
Name:NGUYEN, THERESA T
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:THERESA
Other - Middle Name:V
Other - Last Name:TOLIONGCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:THERESA T NGUYEN
Mailing Address - Street 1:80 HAINES MILL RD
Mailing Address - Street 2:
Mailing Address - City:DELRAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08075-1738
Mailing Address - Country:US
Mailing Address - Phone:856-764-8975
Mailing Address - Fax:
Practice Address - Street 1:2604 ROUTE 130 N
Practice Address - Street 2:
Practice Address - City:CINNAMINSON
Practice Address - State:NJ
Practice Address - Zip Code:08077-3017
Practice Address - Country:US
Practice Address - Phone:856-786-8694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02478400183500000X
PARP441698183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist