Provider Demographics
NPI:1689396574
Name:NGUYEN, TAN NHAT (PHARM D)
Entity Type:Individual
Prefix:
First Name:TAN
Middle Name:NHAT
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 1:11131 CLARISSA ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-1206
Mailing Address - Country:US
Mailing Address - Phone:714-496-9567
Mailing Address - Fax:
Practice Address - Street 1:2000 E 17TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-8647
Practice Address - Country:US
Practice Address - Phone:714-543-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86760183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist