MEDICARE: JOHN DC NGUYEN RPH

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	PH00014770	WA

General Provider Information

NPI Number	:	1710580196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN DC NGUYEN RPH

Provider Business Mailing Address
First Line	:	2120 RAINIER AVE S
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98144-4623
Country	:	US
Telephone Number	:	206-323-9525
Fax Number	:	206-323-9526

Provider Business Practice Location Address
First Line	:	2120 RAINIER AVE S
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98144-4623
Country	:	US
Telephone Number	:	206-323-9525
Fax Number	:	206-323-9526

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

Provider Enumeration Date	:	11/18/2020
Last Update Date	:	11/18/2020

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