Provider Demographics
NPI:1457593105
Name:NGUYEN-JOHNSON, CHI LAN
Entity Type:Individual
Prefix:MRS
First Name:CHI
Middle Name:LAN
Last Name:NGUYEN-JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHI
Other - Middle Name:LAN
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:473 CABRILLO ST
Mailing Address - Street 2:
Mailing Address - City:PRESIDIO OF MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93944-3201
Mailing Address - Country:US
Mailing Address - Phone:831-242-5382
Mailing Address - Fax:
Practice Address - Street 1:473 CABRILLO ST
Practice Address - Street 2:
Practice Address - City:PRESIDIO OF MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93944-3201
Practice Address - Country:US
Practice Address - Phone:831-242-5382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-26
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13698183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist