Provider Demographics
NPI:1710973169
Name:NGUYEN, MYHANH L (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MYHANH
Middle Name:L
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 JOSE FIGUERES AVE
Mailing Address - Street 2:STE 235
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1588
Mailing Address - Country:US
Mailing Address - Phone:408-254-8884
Mailing Address - Fax:408-254-8885
Practice Address - Street 1:200 JOSE FIGUERES AVE
Practice Address - Street 2:STE 235
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1588
Practice Address - Country:US
Practice Address - Phone:408-254-8884
Practice Address - Fax:408-254-8885
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY37035183500000X
CARPH41755183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0671640002Medicare PIN
CA0671640002Medicare NSC