Provider Demographics
NPI:1912254293
Name:NGUYEN, LYNDA TRUONG NGOC (PHARMD)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:TRUONG NGOC
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-4615
Mailing Address - Country:US
Mailing Address - Phone:510-752-6291
Mailing Address - Fax:
Practice Address - Street 1:4501 BROADWAY
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-4615
Practice Address - Country:US
Practice Address - Phone:510-752-6291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66469183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist