Provider Demographics
NPI:1396057790
Name:NGUYEN, SUSAN T (PHARMD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 ROOSELVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-1040
Mailing Address - Country:US
Mailing Address - Phone:215-338-9639
Mailing Address - Fax:215-338-9637
Practice Address - Street 1:7101 ROOSELVELT BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-1040
Practice Address - Country:US
Practice Address - Phone:215-338-9639
Practice Address - Fax:215-338-9637
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP441758183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist