Provider Demographics
NPI:1457422511
Name:VIEN, NHON TAN (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:NHON
Middle Name:TAN
Last Name:VIEN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 ROSEMARIE LN STE C
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6970
Mailing Address - Country:US
Mailing Address - Phone:209-473-4277
Mailing Address - Fax:209-473-4278
Practice Address - Street 1:1412 ROSEMARIE LN STE C
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6970
Practice Address - Country:US
Practice Address - Phone:209-473-4277
Practice Address - Fax:209-473-4278
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH38498183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA36010Medicaid