Provider Demographics
NPI:1649671595
Name:NGUYEN, THUY TRAM LY (PHARMD)
Entity type:Individual
Prefix:
First Name:THUY TRAM
Middle Name:LY
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 1:1870 MCCULLOCH BLVD N
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5744
Mailing Address - Country:US
Mailing Address - Phone:928-453-8118
Mailing Address - Fax:928-453-0027
Practice Address - Street 1:1870 MCCULLOCH BLVD N
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5744
Practice Address - Country:US
Practice Address - Phone:928-453-8118
Practice Address - Fax:928-453-0027
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS030248183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist