Provider Demographics
NPI:1740580034
Name:NGUYEN, KHANG NGUYEN (PHARM D)
Entity type:Individual
Prefix:
First Name:KHANG
Middle Name:NGUYEN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 N LITCHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-1224
Mailing Address - Country:US
Mailing Address - Phone:623-925-0233
Mailing Address - Fax:623-925-2352
Practice Address - Street 1:390 N LITCHFIELD RD
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-1224
Practice Address - Country:US
Practice Address - Phone:623-925-0233
Practice Address - Fax:623-925-2352
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS013435183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist