Provider Demographics
NPI:1912216110
Name:NGUYEN, VINH KHOA PHUC (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:VINH KHOA
Middle Name:PHUC
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 PRELUDE DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-3317
Mailing Address - Country:US
Mailing Address - Phone:408-234-1165
Mailing Address - Fax:
Practice Address - Street 1:1451 PRELUDE DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-3317
Practice Address - Country:US
Practice Address - Phone:408-234-1165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA627811835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy