Provider Demographics
NPI:1780159236
Name:NGUYEN, ANH THUC
Entity type:Individual
Prefix:
First Name:ANH THUC
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5806 MALCOMBORO DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77041-6584
Mailing Address - Country:US
Mailing Address - Phone:504-994-4608
Mailing Address - Fax:
Practice Address - Street 1:1313 FRY RD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-3399
Practice Address - Country:US
Practice Address - Phone:281-578-1123
Practice Address - Fax:281-578-0259
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47667183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist