Provider Demographics
NPI:1912209743
Name:NGUYEN, THAI Q (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:THAI
Middle Name:Q
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 FORDHAM ST
Mailing Address - Street 2:SAN DIEGO
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-5339
Mailing Address - Country:US
Mailing Address - Phone:619-295-6269
Mailing Address - Fax:
Practice Address - Street 1:3250 FORDHAM ST
Practice Address - Street 2:SAN DIEGO
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-5339
Practice Address - Country:US
Practice Address - Phone:619-295-6269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50346183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist