MEDICARE: MINH THUOC THI 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	RPH 52559	CA

General Provider Information

NPI Number	:	1609197599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINH THUOC THI NGUYEN

Provider Business Mailing Address
First Line	:	8704 SHANNON RIVER CIR
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-5509
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17904 MAGNOLIA ST
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-5039
Country	:	US
Telephone Number	:	714-962-9713
Fax Number	:	714-964-0419

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

Provider Enumeration Date	:	06/15/2010
Last Update Date	:	02/24/2015

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