Provider Demographics
NPI:1740811884
Name:NGUYEN, DUC THANH NGO (PHARMD)
Entity type:Individual
Prefix:
First Name:DUC THANH
Middle Name:NGO
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 1:18220 FALLENLEAF CIR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5701
Mailing Address - Country:US
Mailing Address - Phone:714-467-9122
Mailing Address - Fax:
Practice Address - Street 1:18220 FALLENLEAF CIR
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-5701
Practice Address - Country:US
Practice Address - Phone:714-467-9122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH81874183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist