Provider Demographics
NPI:1184231045
Name:NGUYEN, THI NGOC TU (RPH)
Entity type:Individual
Prefix:
First Name:THI
Middle Name:NGOC TU
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7194 SCHILLING AVE APT 76
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-5966
Mailing Address - Country:US
Mailing Address - Phone:714-623-2260
Mailing Address - Fax:
Practice Address - Street 1:1645 E 103RD ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90002-2923
Practice Address - Country:US
Practice Address - Phone:323-564-5787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82930183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist