Provider Demographics
NPI:1770067969
Name:NGUYEN, JULIEN VAN (PHARMD)
Entity type:Individual
Prefix:
First Name:JULIEN
Middle Name:VAN
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 1:10107 TENNYSON LN
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-0350
Mailing Address - Country:US
Mailing Address - Phone:843-902-4717
Mailing Address - Fax:
Practice Address - Street 1:810 ELM ST E
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:SC
Practice Address - Zip Code:29924-2610
Practice Address - Country:US
Practice Address - Phone:803-914-0318
Practice Address - Fax:803-914-0311
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37808183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist