Provider Demographics
NPI:1689841355
Name:NGUYEN, JENNY PHUONG (PHARMD)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:PHUONG
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 SWEETWATER RD
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-5628
Mailing Address - Country:US
Mailing Address - Phone:619-463-9848
Mailing Address - Fax:619-463-9628
Practice Address - Street 1:661 SWEETWATER RD
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-5628
Practice Address - Country:US
Practice Address - Phone:619-463-9848
Practice Address - Fax:619-463-9628
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56529183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist