Provider Demographics
NPI:1720358963
Name:NGUYEN, KIM SANG THI (PHARMD)
Entity Type:Individual
Prefix:
First Name:KIM SANG
Middle Name:THI
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 1:9885 BLACKHAWK BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77075-2247
Mailing Address - Country:US
Mailing Address - Phone:713-991-2752
Mailing Address - Fax:
Practice Address - Street 1:9885 BLACKHAWK BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77075-2247
Practice Address - Country:US
Practice Address - Phone:713-991-2752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50776183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist