Provider Demographics
NPI:1750960712
Name:NGUYEN, THAI QUOC (DOCTOR OF PHARMACY)
Entity type:Individual
Prefix:DR
First Name:THAI
Middle Name:QUOC
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DOCTOR OF PHARMACY
Other - Prefix:DR
Other - First Name:THAI
Other - Middle Name:QUOC
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DOCTOR OF PHARMACY
Mailing Address - Street 1:8908 SABODA CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-1117
Mailing Address - Country:US
Mailing Address - Phone:813-503-0490
Mailing Address - Fax:
Practice Address - Street 1:4730 N HABANA AVE STE 305
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7187
Practice Address - Country:US
Practice Address - Phone:800-544-9177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS54194261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service