Provider Demographics
NPI:1740705284
Name:NGUYEN, DAT TAN (PHARMD)
Entity type:Individual
Prefix:
First Name:DAT
Middle Name:TAN
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 1:228 W MCDOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:ALTURAS
Mailing Address - State:CA
Mailing Address - Zip Code:96101-3934
Mailing Address - Country:US
Mailing Address - Phone:714-887-3130
Mailing Address - Fax:
Practice Address - Street 1:228 W MCDOWELL AVE
Practice Address - Street 2:
Practice Address - City:ALTURAS
Practice Address - State:CA
Practice Address - Zip Code:96101-3934
Practice Address - Country:US
Practice Address - Phone:530-233-5131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-05
Last Update Date:2017-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75289183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist