Provider Demographics
NPI:1649980004
Name:TA, MINH HUNG NGUYEN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MINH
Middle Name:HUNG NGUYEN
Last Name:TA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 HAMMONDS LN APT 342
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21225-3681
Mailing Address - Country:US
Mailing Address - Phone:443-310-7201
Mailing Address - Fax:
Practice Address - Street 1:10000 BALTIMORE NATIONAL PIKE
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-3612
Practice Address - Country:US
Practice Address - Phone:410-720-3002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28912183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD40009256900Medicaid