MEDICARE: DAVID DAI NGUYEN PHARMACIST

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	33883	TX

General Provider Information

NPI Number	:	1346871787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID DAI NGUYEN PHARMACIST

Provider Business Mailing Address
First Line	:	301 S BOWEN RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76013-1255
Country	:	US
Telephone Number	:	817-277-0072
Fax Number	:	817-275-7098

Provider Business Practice Location Address
First Line	:	301 S BOWEN RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76013-1255
Country	:	US
Telephone Number	:	817-277-0072
Fax Number	:	817-275-7098

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

Provider Enumeration Date	:	02/03/2020
Last Update Date	:	02/03/2020

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