Provider Demographics
NPI:1265260681
Name:NGUYEN, DIANA THAO (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:THAO
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:NEWTONVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02460-1927
Mailing Address - Country:US
Mailing Address - Phone:857-294-4455
Mailing Address - Fax:857-297-4458
Practice Address - Street 1:317 WALNUT ST
Practice Address - Street 2:
Practice Address - City:NEWTONVILLE
Practice Address - State:MA
Practice Address - Zip Code:02460-1927
Practice Address - Country:US
Practice Address - Phone:857-294-4455
Practice Address - Fax:857-297-4458
Is Sole Proprietor?:No
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPI163116183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist