Provider Demographics
NPI:1700496114
Name:NGUYEN, AVY (RPH)
Entity Type:Individual
Prefix:
First Name:AVY
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:PHUONG
Other - Middle Name:THI THANH
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8000 MONTGOMERY BLVD NE APT 721
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1643
Mailing Address - Country:US
Mailing Address - Phone:714-251-8935
Mailing Address - Fax:
Practice Address - Street 1:3701 CONSTITUTION AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-5623
Practice Address - Country:US
Practice Address - Phone:505-251-9443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-01
Last Update Date:2020-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00009303183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist