Provider Demographics
NPI:1770033060
Name:HVEZDA, MARI CAM VI NGUYEN (RPH)
Entity Type:Individual
Prefix:
First Name:MARI CAM VI
Middle Name:NGUYEN
Last Name:HVEZDA
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 1:1601 W CAPITOL AVE
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-3219
Mailing Address - Country:US
Mailing Address - Phone:916-372-3111
Mailing Address - Fax:
Practice Address - Street 1:1601 W CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-3219
Practice Address - Country:US
Practice Address - Phone:916-372-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75663183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist