Provider Demographics
NPI:1982340931
Name:VO, DAN NGUYEN HUYEN
Entity Type:Individual
Prefix:
First Name:DAN NGUYEN
Middle Name:HUYEN
Last Name:VO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6804 PETER PAN PL
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-4924
Mailing Address - Country:US
Mailing Address - Phone:904-377-0859
Mailing Address - Fax:
Practice Address - Street 1:6804 PETER PAN PL
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-4924
Practice Address - Country:US
Practice Address - Phone:904-377-0859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS63976183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist