Provider Demographics
NPI:1013127547
Name:NGUYEN, AUDREY GYUNG (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:GYUNG
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MS
Other - First Name:AUDREY
Other - Middle Name:GYUNG
Other - Last Name:YAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3882 W TETER ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-3976
Mailing Address - Country:US
Mailing Address - Phone:208-409-0912
Mailing Address - Fax:208-706-1543
Practice Address - Street 1:520 S EAGLE RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6308
Practice Address - Country:US
Practice Address - Phone:208-706-1523
Practice Address - Fax:208-706-1543
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP59281835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy