Provider Demographics
NPI:1336425784
Name:NGUYEN, HONGCAM TAN (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:HONGCAM
Middle Name:TAN
Last Name:NGUYEN
Suffix:
Gender:F
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 1:7420 STATE ROAD 54
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-6110
Mailing Address - Country:US
Mailing Address - Phone:727-376-5064
Mailing Address - Fax:727-376-3981
Practice Address - Street 1:7420 STATE ROAD 54
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-6110
Practice Address - Country:US
Practice Address - Phone:727-376-5064
Practice Address - Fax:727-376-3981
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFS41585183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist