Provider Demographics
NPI:1790022564
Name:NGUYEN, NA KIEU (PHARM D)
Entity Type:Individual
Prefix:
First Name:NA
Middle Name:KIEU
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12425 HAGEN RANCH RD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-4107
Mailing Address - Country:US
Mailing Address - Phone:561-292-4494
Mailing Address - Fax:561-292-4499
Practice Address - Street 1:12425 HAGEN RANCH RD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-4107
Practice Address - Country:US
Practice Address - Phone:561-292-4494
Practice Address - Fax:561-292-4499
Is Sole Proprietor?:No
Enumeration Date:2013-01-13
Last Update Date:2013-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43825183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist