MEDICARE: MRS. PHUONG-DUYEN THI NGUYEN RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH72119	CA

General Provider Information

NPI Number	:	1295455566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PHUONG-DUYEN THI NGUYEN RPH

Provider Business Mailing Address
First Line	:	5507 EL CAJON BLVD STE E
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-3624
Country	:	US
Telephone Number	:	619-458-9660
Fax Number	:	619-326-8829

Provider Business Practice Location Address
First Line	:	5507 EL CAJON BLVD STE E
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-3624
Country	:	US
Telephone Number	:	619-458-9660
Fax Number	:	619-326-8829

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2022
Last Update Date	:	08/29/2022

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