Provider Demographics
NPI:1013091826
Name:NGUYEN, PERRY TAN (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:PERRY
Middle Name:TAN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2459 E FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-5754
Mailing Address - Country:US
Mailing Address - Phone:323-589-4929
Mailing Address - Fax:323-589-3531
Practice Address - Street 1:2459 E FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-5754
Practice Address - Country:US
Practice Address - Phone:323-589-4929
Practice Address - Fax:323-589-3531
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH42961183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA428910OtherMEDICAL PROVIDER
CAPHA431820OtherMEDICAL PROVIDER NUMBER