Provider Demographics
NPI:1841614682
Name:NGUYEN, BINH NGU (PHARMD)
Entity Type:Individual
Prefix:
First Name:BINH
Middle Name:NGU
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 1:275 N. EL CIELO RD
Mailing Address - Street 2:C326
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3518
Mailing Address - Country:US
Mailing Address - Phone:760-969-6560
Mailing Address - Fax:
Practice Address - Street 1:275 N EL CIELO RD # C326
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6972
Practice Address - Country:US
Practice Address - Phone:760-969-6560
Practice Address - Fax:760-328-2230
Is Sole Proprietor?:No
Enumeration Date:2014-02-14
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA695241835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1841614682Medicaid