Provider Demographics
NPI:1700118965
Name:NGUYEN, QUOC PHUONG
Entity Type:Individual
Prefix:
First Name:QUOC
Middle Name:PHUONG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9709 SILVERDALE WAY NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-9445
Mailing Address - Country:US
Mailing Address - Phone:360-692-7536
Mailing Address - Fax:360-692-7571
Practice Address - Street 1:9709 SILVERDALE WAY NW
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-9445
Practice Address - Country:US
Practice Address - Phone:360-692-7536
Practice Address - Fax:360-692-7571
Is Sole Proprietor?:No
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60017267183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist