Provider Demographics
NPI:1790404978
Name:NGUYEN, TAVIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:TAVIN
Middle Name:
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 1:3632 JOHNSON MILL BLVD APT 305
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-6373
Mailing Address - Country:US
Mailing Address - Phone:479-739-7227
Mailing Address - Fax:
Practice Address - Street 1:8600 HIGHWAY 71 S
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72908-8042
Practice Address - Country:US
Practice Address - Phone:479-289-6898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD16274183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist