Provider Demographics
NPI:1811592439
Name:NGUYEN, JOHN MANH CUONG
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MANH CUONG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5122 PIMLICO LN UNIT 307
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-6570
Mailing Address - Country:US
Mailing Address - Phone:480-628-9225
Mailing Address - Fax:
Practice Address - Street 1:1003 SANTA BARBARA BLVD
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-2852
Practice Address - Country:US
Practice Address - Phone:239-772-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS61555183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist