Provider Demographics
NPI:1952639783
Name:NGUYEN, EDWARD
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3316 AVENUE H
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-2801
Mailing Address - Country:US
Mailing Address - Phone:281-342-5588
Mailing Address - Fax:281-342-5348
Practice Address - Street 1:3316 AVENUE H
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-2801
Practice Address - Country:US
Practice Address - Phone:281-342-5588
Practice Address - Fax:281-342-5348
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-07
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41069183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist