MEDICARE: JIMMY 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	1835P2201X	Ambulatory Care Pharmacist	8522028-1701	UT

General Provider Information

NPI Number	:	1487295952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIMMY NGUYEN

Provider Business Mailing Address
First Line	:	828 S 900 W
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84104-1455
Country	:	US
Telephone Number	:	801-364-2564
Fax Number	:

Provider Business Practice Location Address
First Line	:	828 S 900 W
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84104-1455
Country	:	US
Telephone Number	:	801-364-2564
Fax Number	:	801-363-4633

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

Provider Enumeration Date	:	10/04/2019
Last Update Date	:	10/04/2019

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Directions to “ JIMMY NGUYEN ” Practice Location

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