Provider Demographics
NPI:1295093664
Name:GRUDZIEN, DOAN NGUYEN
Entity type:Individual
Prefix:
First Name:DOAN
Middle Name:NGUYEN
Last Name:GRUDZIEN
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 1:11326 NE 117TH ST
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-7028
Mailing Address - Country:US
Mailing Address - Phone:425-314-4969
Mailing Address - Fax:
Practice Address - Street 1:11326 NE 117TH ST
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7028
Practice Address - Country:US
Practice Address - Phone:425-314-4969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIR 60168982183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist