MEDICARE: MRS. TRANG PHUONG 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	183500000X	Pharmacist	RPH 44662	CA
2	183500000X	Pharmacist	44662	CA

General Provider Information

NPI Number	:	1609176676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TRANG PHUONG NGUYEN PHARMACIST

Provider Business Mailing Address
First Line	:	1771 E CAPITOL EXPY
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95121-1561
Country	:	US
Telephone Number	:	408-238-1770
Fax Number	:	408-238-7821

Provider Business Practice Location Address
First Line	:	1771 E CAPITOL EXPY
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95121-1561
Country	:	US
Telephone Number	:	408-238-1770
Fax Number	:	408-238-7821

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

Provider Enumeration Date	:	10/25/2010
Last Update Date	:	10/25/2010

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