Provider Demographics
NPI:1902409360
Name:NGUYEN, THANH D (RPH)
Entity Type:Individual
Prefix:MR
First Name:THANH
Middle Name:D
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 S MAIN ST STE 103
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2089
Mailing Address - Country:US
Mailing Address - Phone:206-323-6003
Mailing Address - Fax:206-323-6552
Practice Address - Street 1:1221 S MAIN ST STE 103
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-2089
Practice Address - Country:US
Practice Address - Phone:206-323-6003
Practice Address - Fax:206-323-6552
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00022253183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist