Provider Demographics
NPI:1750167540
Name:KWAN, NGUYETANH THI (RPH)
Entity type:Individual
Prefix:
First Name:NGUYETANH
Middle Name:THI
Last Name:KWAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:NGUYET ANH
Other - Middle Name:THI
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:2623 BIG VINE CT
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-7213
Mailing Address - Country:US
Mailing Address - Phone:832-724-9310
Mailing Address - Fax:
Practice Address - Street 1:2623 BIG VINE CT
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-7213
Practice Address - Country:US
Practice Address - Phone:832-724-9310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX316271835C0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835C0205XPharmacy Service ProvidersPharmacistCritical Care