Provider Demographics
NPI:1831170075
Name:GISELE NGUYEN INC
Entity type:Organization
Organization Name:GISELE NGUYEN INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GISELE
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:904-620-6580
Mailing Address - Street 1:1182 E HOLT AVE
Mailing Address - Street 2:STE A
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-5833
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1182 E HOLT AVE
Practice Address - Street 2:STE A
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-5833
Practice Address - Country:US
Practice Address - Phone:909-620-6580
Practice Address - Fax:909-620-6651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-06
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY487613336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0595477OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CAPHA397660Medicaid
0595477OtherNCPDP PROVIDER IDENTIFICATION NUMBER