Provider Demographics
NPI:1760868731
Name:NGUYEN, PHI TIEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:PHI
Middle Name:TIEN
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 1:3200 ZANKER RD UNIT 1303
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95134-1975
Mailing Address - Country:US
Mailing Address - Phone:240-938-0753
Mailing Address - Fax:
Practice Address - Street 1:440 BLOSSOM HILL RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-1608
Practice Address - Country:US
Practice Address - Phone:408-229-8013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72723183500000X
MD23249183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist