Provider Demographics
NPI:1881979284
Name:NGUYEN, DANG THE (RPH)
Entity type:Individual
Prefix:MR
First Name:DANG
Middle Name:THE
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 1:13003 VALARESSA LN
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90601-1061
Mailing Address - Country:US
Mailing Address - Phone:626-288-2154
Mailing Address - Fax:626-288-2742
Practice Address - Street 1:2750 SAN GABRIEL BLVD
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-3256
Practice Address - Country:US
Practice Address - Phone:626-288-2154
Practice Address - Fax:626-288-2742
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57455183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist