Provider Demographics
NPI:1912500919
Name:NGUYEN, KATIE D (RPH)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:D
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 GRANT RD
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-4710
Mailing Address - Country:US
Mailing Address - Phone:339-203-5447
Mailing Address - Fax:
Practice Address - Street 1:575 BROADWAY
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-2039
Practice Address - Country:US
Practice Address - Phone:781-321-1017
Practice Address - Fax:781-321-1643
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH233028183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist