MEDICARE: DR. NHAT TAN NGUYEN THAI PHARM.D

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	73732	CA

General Provider Information

NPI Number	:	1598137507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NHAT TAN NGUYEN THAI PHARM.D

Provider Business Mailing Address
First Line	:	1252 N FORMOSA AVE
Second Line	:	APT 2
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-5800
Country	:	US
Telephone Number	:	813-451-4117
Fax Number	:

Provider Business Practice Location Address
First Line	:	1252 N FORMOSA AVE
Second Line	:	APT 2
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-5800
Country	:	US
Telephone Number	:	813-451-4117
Fax Number	:

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

Provider Enumeration Date	:	10/29/2015
Last Update Date	:	10/29/2015

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