MEDICARE: ELISE NGUYEN

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	14922	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457945891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISE NGUYEN

Provider Business Mailing Address
First Line	:	1058 S FEDERAL BLVD
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80219-4102
Country	:	US
Telephone Number	:	303-975-1700
Fax Number	:	303-975-1799

Provider Business Practice Location Address
First Line	:	1058 S FEDERAL BLVD
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80219-4102
Country	:	US
Telephone Number	:	303-975-1700
Fax Number	:	303-975-1799

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

Provider Enumeration Date	:	02/25/2021
Last Update Date	:	03/11/2021

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Directions to “ ELISE NGUYEN ” Practice Location

Language	Start Address	Practice Location

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