Provider Demographics
NPI:1811216450
Name:NGUYEN, AN THU (RPH)
Entity Type:Individual
Prefix:DR
First Name:AN
Middle Name:THU
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4790 IRVINE BLVD
Mailing Address - Street 2:#105-211
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-1973
Mailing Address - Country:US
Mailing Address - Phone:714-368-0602
Mailing Address - Fax:714-368-0602
Practice Address - Street 1:12897 HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-5808
Practice Address - Country:US
Practice Address - Phone:714-636-1143
Practice Address - Fax:714-636-1856
Is Sole Proprietor?:No
Enumeration Date:2010-05-21
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH50747183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist