Provider Demographics
NPI:1760574743
Name:HA, CONNIE NGUYEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:NGUYEN
Last Name:HA
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 1:3200 PAYNE AVE APT 108
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-3524
Mailing Address - Country:US
Mailing Address - Phone:408-851-3938
Mailing Address - Fax:408-851-3935
Practice Address - Street 1:710 LAWRENCE EXPY
Practice Address - Street 2:CLINICAL PHARMACY, M3453
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-5173
Practice Address - Country:US
Practice Address - Phone:408-851-3938
Practice Address - Fax:408-851-3935
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55734183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist