Provider Demographics
NPI:1700141876
Name:NGUYEN, LARRY L (PHARMD)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:L
Last Name:NGUYEN
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 1:12725 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98168-2683
Mailing Address - Country:US
Mailing Address - Phone:206-242-7942
Mailing Address - Fax:
Practice Address - Street 1:12725 1ST AVE S
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98168-2683
Practice Address - Country:US
Practice Address - Phone:206-242-7942
Practice Address - Fax:206-439-0115
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00056480183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist