Provider Demographics
NPI:1013574219
Name:NGUYEN, LINH THI THUY
Entity Type:Individual
Prefix:
First Name:LINH
Middle Name:THI THUY
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LINH
Other - Middle Name:T
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:920 SUNNYSLOPE RD
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-5784
Mailing Address - Country:US
Mailing Address - Phone:140-853-2295
Mailing Address - Fax:
Practice Address - Street 1:920 SUNNYSLOPE RD
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-5784
Practice Address - Country:US
Practice Address - Phone:408-532-2952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-22
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47144183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA47144OtherPHARMACIST
CA18OtherPHARMACIST