Provider Demographics
NPI:1245886514
Name:NGUYEN, THUY AN NGOC
Entity type:Individual
Prefix:
First Name:THUY AN
Middle Name:NGOC
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5808 RYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-6600
Mailing Address - Country:US
Mailing Address - Phone:407-929-0470
Mailing Address - Fax:
Practice Address - Street 1:4300 N UNIVERSITY DR STE C101
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-6243
Practice Address - Country:US
Practice Address - Phone:754-200-9767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS58108183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist