Provider Demographics
NPI:1912341512
Name:NGUYEN, THIET HUU
Entity Type:Individual
Prefix:
First Name:THIET
Middle Name:HUU
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4850 E 62ND AVE
Mailing Address - Street 2:
Mailing Address - City:COMMERCE CITY
Mailing Address - State:CO
Mailing Address - Zip Code:80022-3288
Mailing Address - Country:US
Mailing Address - Phone:303-288-6629
Mailing Address - Fax:303-289-8043
Practice Address - Street 1:4850 E 62ND AVE
Practice Address - Street 2:
Practice Address - City:COMMERCE CITY
Practice Address - State:CO
Practice Address - Zip Code:80022-3288
Practice Address - Country:US
Practice Address - Phone:303-288-6629
Practice Address - Fax:303-289-8043
Is Sole Proprietor?:No
Enumeration Date:2013-04-25
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15847183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist