Provider Demographics
NPI:1972103646
Name:NGUYEN, ANTHONY T (RPH)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:T
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 1:61 CATOCTIN CIR NE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-3100
Mailing Address - Country:US
Mailing Address - Phone:703-771-9518
Mailing Address - Fax:703-777-3690
Practice Address - Street 1:61 CATOCTIN CIR NE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-3100
Practice Address - Country:US
Practice Address - Phone:703-771-9518
Practice Address - Fax:703-777-3690
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202204339183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist