Provider Demographics
NPI:1942520580
Name:NGUYEN, PETER DINH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:DINH
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 1:1180 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92583-6318
Mailing Address - Country:US
Mailing Address - Phone:951-487-1915
Mailing Address - Fax:951-487-1749
Practice Address - Street 1:1180 N STATE ST
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-6318
Practice Address - Country:US
Practice Address - Phone:951-487-1915
Practice Address - Fax:951-487-1749
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-06
Last Update Date:2010-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57833183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist