Provider Demographics
NPI:1356727333
Name:NGUYEN, VY (PHAMD)
Entity type:Individual
Prefix:
First Name:VY
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHAMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2816 KENNEWICK PL NE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-2278
Mailing Address - Country:US
Mailing Address - Phone:360-261-3041
Mailing Address - Fax:
Practice Address - Street 1:4300 NE 4TH ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98059-5008
Practice Address - Country:US
Practice Address - Phone:425-226-2508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60389615183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH60389615OtherWASHINGTON STATE DEPARTMENT OF HEALTH