Provider Demographics
NPI:1740672807
Name:NGUYEN, HIEU
Entity type:Individual
Prefix:
First Name:HIEU
Middle Name:
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 1:1101 OUTLET COLLECTION DR SW
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98001-6511
Mailing Address - Country:US
Mailing Address - Phone:253-333-8191
Mailing Address - Fax:253-333-1265
Practice Address - Street 1:1101 OUTLET COLLECTION DR SW
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001-6511
Practice Address - Country:US
Practice Address - Phone:253-333-8191
Practice Address - Fax:253-333-1265
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00054093183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist