Provider Demographics
NPI:1770965287
Name:NGUYEN, QUANG CUU (RPH)
Entity type:Individual
Prefix:
First Name:QUANG
Middle Name:CUU
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E CARSON ST
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-2702
Mailing Address - Country:US
Mailing Address - Phone:310-830-7237
Mailing Address - Fax:310-834-3753
Practice Address - Street 1:110 E CARSON ST
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-2702
Practice Address - Country:US
Practice Address - Phone:310-830-7237
Practice Address - Fax:310-834-3753
Is Sole Proprietor?:No
Enumeration Date:2015-06-19
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56352183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist