Provider Demographics
NPI:1972160349
Name:NGUYEN, THUY MONG (RPH)
Entity Type:Individual
Prefix:
First Name:THUY
Middle Name:MONG
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 1:5850 NE PRESCOTT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97218-2232
Mailing Address - Country:US
Mailing Address - Phone:503-284-7268
Mailing Address - Fax:503-249-7202
Practice Address - Street 1:5850 NE PRESCOTT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97218-2232
Practice Address - Country:US
Practice Address - Phone:503-284-7268
Practice Address - Fax:503-249-7202
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0008967-P183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist