Provider Demographics
NPI:1770249823
Name:NGUYEN, STEVEN XUAN
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:XUAN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 CYPRESS LN
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:PA
Mailing Address - Zip Code:19070-1638
Mailing Address - Country:US
Mailing Address - Phone:949-228-8794
Mailing Address - Fax:
Practice Address - Street 1:4523-25 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-1914
Practice Address - Country:US
Practice Address - Phone:215-222-3349
Practice Address - Fax:215-222-4044
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP437225183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty