Provider Demographics
NPI:1821383001
Name:NGUYEN, JACQUELINE QUYEN (RPH)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:QUYEN
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 1:871 MYRTLE ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-1836
Mailing Address - Country:US
Mailing Address - Phone:408-781-7946
Mailing Address - Fax:
Practice Address - Street 1:6091 MERIDIAN AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95120-2765
Practice Address - Country:US
Practice Address - Phone:408-927-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54888183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist