Provider Demographics
NPI:1912289976
Name:HUYNH, NINA TRANG (PHARMD)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:TRANG
Last Name:HUYNH
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 1:69 FAIRFAX RD # 3
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01610-2052
Mailing Address - Country:US
Mailing Address - Phone:508-450-0161
Mailing Address - Fax:
Practice Address - Street 1:220 GRAFTON ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-4906
Practice Address - Country:US
Practice Address - Phone:508-755-4196
Practice Address - Fax:508-755-6478
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH232410183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist