Provider Demographics
NPI:1851674014
Name:NGUYEN, PHUONG LAN
Entity Type:Individual
Prefix:DR
First Name:PHUONG
Middle Name:LAN
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 1:90 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-3908
Mailing Address - Country:US
Mailing Address - Phone:978-645-1567
Mailing Address - Fax:
Practice Address - Street 1:90 8TH AVE
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-3908
Practice Address - Country:US
Practice Address - Phone:978-645-1567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH232351183500000X
NHR2152183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist