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NPI Code Detail

MEDICARE: KEVIN ANH NGUYEN PHARMD

MEDICARE: KEVIN ANH 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
1183500000XPharmacist52942CA

General Provider Information

NPI Number : 1700192929
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEVIN ANH NGUYEN PHARMD
Provider Business Mailing Address
First Line : 1248 MAGNOLIA AVE
Second Line :
City : REDLANDS
State : CA
Zip : 92373-4902
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1634 E HIGHLAND AVE
Second Line :
City : SAN BERNARDINO
State : CA
Zip : 92404-4616
Country : US
Telephone Number : 909-882-2836
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2010
Last Update Date : 08/25/2010

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