Provider Demographics
NPI:1336610039
Name:NGUYEN, HAN NGOC (RPH)
Entity Type:Individual
Prefix:
First Name:HAN
Middle Name:NGOC
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12506 HIGHWAY 73
Mailing Address - Street 2:
Mailing Address - City:GEISMAR
Mailing Address - State:LA
Mailing Address - Zip Code:70734-3209
Mailing Address - Country:US
Mailing Address - Phone:225-677-7607
Mailing Address - Fax:225-677-7608
Practice Address - Street 1:12506 HIGHWAY 73
Practice Address - Street 2:
Practice Address - City:GEISMAR
Practice Address - State:LA
Practice Address - Zip Code:70734-3209
Practice Address - Country:US
Practice Address - Phone:225-677-7607
Practice Address - Fax:225-677-7608
Is Sole Proprietor?:No
Enumeration Date:2018-12-07
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022771183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3275961Medicaid