Provider Demographics
NPI:1841786167
Name:NGUYEN, ELIZABETH O
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:O
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 THORME ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-4019
Mailing Address - Country:US
Mailing Address - Phone:203-243-8366
Mailing Address - Fax:
Practice Address - Street 1:1790 POST RD E
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-5607
Practice Address - Country:US
Practice Address - Phone:203-254-9461
Practice Address - Fax:844-411-6460
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0013324183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist