Provider Demographics
NPI:1750103719
Name:NGUYEN, THUAN BAO (PHARM D)
Entity type:Individual
Prefix:DR
First Name:THUAN
Middle Name:BAO
Last Name:NGUYEN
Suffix:
Gender:F
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 1:9097 CROCUS AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-1432
Mailing Address - Country:US
Mailing Address - Phone:714-737-8411
Mailing Address - Fax:
Practice Address - Street 1:1801 W ROMNEYA DR STE 108
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1824
Practice Address - Country:US
Practice Address - Phone:714-833-5723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33194183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty