Provider Demographics
NPI:1265885586
Name:NGUYEN, ANDRE (RPH)
Entity type:Individual
Prefix:MR
First Name:ANDRE
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6299 BRISTOL PKWY
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6903
Mailing Address - Country:US
Mailing Address - Phone:310-641-4426
Mailing Address - Fax:310-641-6391
Practice Address - Street 1:6299 BRISTOL PKWY
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6903
Practice Address - Country:US
Practice Address - Phone:310-641-4426
Practice Address - Fax:310-641-6391
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49734183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist