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NPI Code Detail

MEDICARE: PHU LUU NGUYEN PHARMD

MEDICARE:   PHU LUU NGUYEN  PHARMD
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
1183500000XPharmacist41731TX

General Provider Information

NPI Number : 1639407158
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHU LUU NGUYEN PHARMD
Provider Business Mailing Address
First Line : 2901 E BROAD ST
Second Line :
City : MANSFIELD
State : TX
Zip : 76063-9147
Country : US
Telephone Number : 682-518-7219
Fax Number :
Provider Business Practice Location Address
First Line : 2901 E BROAD ST
Second Line :
City : MANSFIELD
State : TX
Zip : 76063-9147
Country : US
Telephone Number : 682-518-7219
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2009
Last Update Date : 11/20/2009

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Directions to “ PHU LUU NGUYEN PHARMD” Practice Location

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