Provider Demographics
NPI:1821711045
Name:NGUYEN, THAI-BINH TIMOTHY (RPH)
Entity Type:Individual
Prefix:
First Name:THAI-BINH
Middle Name:TIMOTHY
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 RIDGEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:GOLDEN MEADOW
Mailing Address - State:LA
Mailing Address - Zip Code:70357-2534
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16759 HIGHWAY 3235
Practice Address - Street 2:
Practice Address - City:CUT OFF
Practice Address - State:LA
Practice Address - Zip Code:70345-4053
Practice Address - Country:US
Practice Address - Phone:985-632-4727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024527183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist