Provider Demographics
NPI:1134404221
Name:NGUYEN, HONG K (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:HONG
Middle Name:K
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:K
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1008 MONARCH DR
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62629-9658
Mailing Address - Country:US
Mailing Address - Phone:847-452-8173
Mailing Address - Fax:217-789-9642
Practice Address - Street 1:1155 N 9TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-3949
Practice Address - Country:US
Practice Address - Phone:217-789-6514
Practice Address - Fax:217-789-9642
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051292222183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist