Provider Demographics
NPI:1871197525
Name:NGUYEN, MICHAEL P (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
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 1:202 CROCKETT ST APT 222
Mailing Address - Street 2:
Mailing Address - City:CATLIN
Mailing Address - State:IL
Mailing Address - Zip Code:61817-9676
Mailing Address - Country:US
Mailing Address - Phone:630-854-3360
Mailing Address - Fax:
Practice Address - Street 1:102 S STATE ST
Practice Address - Street 2:
Practice Address - City:WESTVILLE
Practice Address - State:IL
Practice Address - Zip Code:61883-1580
Practice Address - Country:US
Practice Address - Phone:217-267-2188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.302577183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist