Provider Demographics
NPI:1336741347
Name:NGUYEN, JAMES PHU (PHARMD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:PHU
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 34TH ST
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:WV
Mailing Address - Zip Code:26105-1623
Mailing Address - Country:US
Mailing Address - Phone:714-213-6757
Mailing Address - Fax:
Practice Address - Street 1:929 E STATE ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2117
Practice Address - Country:US
Practice Address - Phone:740-594-3628
Practice Address - Fax:740-594-3269
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0012074183500000X
OH03439486183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist