Provider Demographics
NPI:1942528211
Name:NGUYEN, KENNETH THANG QUOC (RPH)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:THANG QUOC
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 1:336 W 21ST ST
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-6321
Mailing Address - Country:US
Mailing Address - Phone:631-940-1158
Mailing Address - Fax:
Practice Address - Street 1:336 W 21ST ST
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-6321
Practice Address - Country:US
Practice Address - Phone:631-940-1158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044213183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist