Provider Demographics
NPI:1003223256
Name:NGUYEN, JOHNNY QUOC (PHARMD)
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:QUOC
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:VIET
Other - Middle Name:QUOC
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5048 N RENDEZVOUS WAY
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619
Mailing Address - Country:US
Mailing Address - Phone:714-352-9926
Mailing Address - Fax:
Practice Address - Street 1:7015 N WEST AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-0461
Practice Address - Country:US
Practice Address - Phone:559-440-1404
Practice Address - Fax:559-440-1407
Is Sole Proprietor?:No
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70015183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist