Provider Demographics
NPI:1790048643
Name:NGUYEN, TAM P (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TAM
Middle Name:P
Last Name:NGUYEN
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 1:6727 EVERGREEN WAY
Mailing Address - Street 2:6727 EVERGREEN WAY
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-4551
Mailing Address - Country:US
Mailing Address - Phone:425-353-7539
Mailing Address - Fax:425-513-5586
Practice Address - Street 1:6727 EVERGREEN WAY
Practice Address - Street 2:6727 EVERGREEN WAY
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-4551
Practice Address - Country:US
Practice Address - Phone:425-353-7539
Practice Address - Fax:425-513-5586
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00022506183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6010441Medicaid