Provider Demographics
NPI:1982211603
Name:NGUYEN, ALAN
Entity Type:Individual
Prefix:
First Name:ALAN
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 1:2100 E RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:IRONDEQUOIT
Mailing Address - State:NY
Mailing Address - Zip Code:14622-2641
Mailing Address - Country:US
Mailing Address - Phone:585-338-3229
Mailing Address - Fax:585-338-3253
Practice Address - Street 1:2100 E RIDGE RD
Practice Address - Street 2:
Practice Address - City:IRONDEQUOIT
Practice Address - State:NY
Practice Address - Zip Code:14622-2641
Practice Address - Country:US
Practice Address - Phone:585-338-3229
Practice Address - Fax:585-338-3253
Is Sole Proprietor?:No
Enumeration Date:2020-09-27
Last Update Date:2020-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY066952183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist