Provider Demographics
NPI:1912340977
Name:NGUYEN, PHUONG T (PHARMD)
Entity Type:Individual
Prefix:
First Name:PHUONG
Middle Name:T
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 1:15051 E 104TH AVE
Mailing Address - Street 2:
Mailing Address - City:COMMERCE CITY
Mailing Address - State:CO
Mailing Address - Zip Code:80022-9706
Mailing Address - Country:US
Mailing Address - Phone:303-286-5470
Mailing Address - Fax:303-286-5472
Practice Address - Street 1:15051 E 104TH AVE
Practice Address - Street 2:
Practice Address - City:COMMERCE CITY
Practice Address - State:CO
Practice Address - Zip Code:80022-9706
Practice Address - Country:US
Practice Address - Phone:303-286-5470
Practice Address - Fax:303-286-5472
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15354183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1OtherINDIVIDUAL