Provider Demographics
NPI:1699032177
Name:NGUYEN, NGA NGUYET (PHARM D)
Entity Type:Individual
Prefix:
First Name:NGA
Middle Name:NGUYET
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 1:8463 LINDENHURST ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-6192
Mailing Address - Country:US
Mailing Address - Phone:951-697-7737
Mailing Address - Fax:
Practice Address - Street 1:12700 DAY ST
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-7521
Practice Address - Country:US
Practice Address - Phone:951-697-7737
Practice Address - Fax:951-697-7741
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH48582183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist