Provider Demographics
NPI:1336773241
Name:NGUYEN, TUAN T
Entity Type:Individual
Prefix:
First Name:TUAN
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 E GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-2479
Mailing Address - Country:US
Mailing Address - Phone:517-548-2401
Mailing Address - Fax:
Practice Address - Street 1:27250 W CANFIELD ST APT 201
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-1039
Practice Address - Country:US
Practice Address - Phone:313-268-0332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-29
Last Update Date:2020-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI530231067183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2345OtherNONE
MI1234OtherNONE
MI9876OtherNONE
MI9877OtherNONE