Provider Demographics
NPI:1851903991
Name:NGUYEN, VINCENT VINH (PHARMD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:VINH
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 1:27 DOGWOOD
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-8380
Mailing Address - Country:US
Mailing Address - Phone:760-580-3451
Mailing Address - Fax:
Practice Address - Street 1:787 L ST
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-2822
Practice Address - Country:US
Practice Address - Phone:707-464-3857
Practice Address - Fax:707-465-1052
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80524183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist