Provider Demographics
NPI:1730460817
Name:NGUYEN, THANH DAI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:THANH
Middle Name:DAI
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 GILMAN ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94710-1532
Mailing Address - Country:US
Mailing Address - Phone:510-528-8274
Mailing Address - Fax:510-528-8659
Practice Address - Street 1:1050 GILMAN ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-1532
Practice Address - Country:US
Practice Address - Phone:510-528-8274
Practice Address - Fax:510-528-8659
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH53526183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist