Provider Demographics
NPI:1952684730
Name:NGUYEN, KHANH-HOA V (RPH)
Entity Type:Individual
Prefix:
First Name:KHANH-HOA
Middle Name:V
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1999 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-3310
Mailing Address - Country:US
Mailing Address - Phone:617-469-2658
Mailing Address - Fax:617-469-5676
Practice Address - Street 1:1999 CENTRE ST
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-3310
Practice Address - Country:US
Practice Address - Phone:617-469-2658
Practice Address - Fax:617-469-5676
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA25287183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist