Provider Demographics
NPI:1255730198
Name:NGUYEN, TUNG (PHARM D)
Entity type:Individual
Prefix:
First Name:TUNG
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 FOXWELL CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95138-1618
Mailing Address - Country:US
Mailing Address - Phone:408-961-4480
Mailing Address - Fax:408-961-4481
Practice Address - Street 1:3255 MISSION COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-1829
Practice Address - Country:US
Practice Address - Phone:408-961-4480
Practice Address - Fax:408-961-4481
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-16
Last Update Date:2014-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69933183500000X
AL14730183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1144641994OtherNPI
CA5650571OtherNABP OR NCPDP