Provider Demographics
NPI:1669771424
Name:NGUYEN, QUYEN T (RPH)
Entity type:Individual
Prefix:
First Name:QUYEN
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 PARRISH LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-3456
Mailing Address - Country:US
Mailing Address - Phone:302-345-5205
Mailing Address - Fax:302-995-0630
Practice Address - Street 1:3209 KIRKWOOD HWY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-6129
Practice Address - Country:US
Practice Address - Phone:302-995-6124
Practice Address - Fax:302-995-0630
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-19
Last Update Date:2011-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP044085L183500000X
DEA1-0002926183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist