Provider Demographics
NPI:1356921258
Name:NGUYEN, KHANH TRINH THI (PHARM D)
Entity type:Individual
Prefix:DR
First Name:KHANH TRINH
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:TRINH
Other - Middle Name:KHANH
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:229 OAK DALE DR
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-3984
Mailing Address - Country:US
Mailing Address - Phone:504-390-2387
Mailing Address - Fax:
Practice Address - Street 1:2500 BELLE CHASSE HWY
Practice Address - Street 2:
Practice Address - City:TERRYTOWN
Practice Address - State:LA
Practice Address - Zip Code:70056-7127
Practice Address - Country:US
Practice Address - Phone:504-391-5152
Practice Address - Fax:504-207-1234
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA016717183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist