Provider Demographics
NPI:1972854834
Name:NGUYEN, THAO NGUYEN THI (PHARMD)
Entity Type:Individual
Prefix:
First Name:THAO NGUYEN
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14430 N 19TH AVE
Mailing Address - Street 2:APT 8
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-6703
Mailing Address - Country:US
Mailing Address - Phone:714-618-1591
Mailing Address - Fax:
Practice Address - Street 1:1620 N 59TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85035-4985
Practice Address - Country:US
Practice Address - Phone:623-849-2084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS019474183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist