Provider Demographics
NPI:1982931051
Name:NGUYEN, CAC (RPH)
Entity Type:Individual
Prefix:
First Name:CAC
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5950 BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-5822
Mailing Address - Country:US
Mailing Address - Phone:972-303-3191
Mailing Address - Fax:972-303-3195
Practice Address - Street 1:2911 RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-5804
Practice Address - Country:US
Practice Address - Phone:972-772-8418
Practice Address - Fax:972-772-5924
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-11
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0038590183500000X
TX38590183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty