MEDICARE: DR. ANNIE 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
1	183500000X	Pharmacist	03230350	OH

General Provider Information

NPI Number	:	1861762106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNIE NGUYEN PHARMD

Provider Business Mailing Address
First Line	:	2209 STONE RIDGE CIR
Second Line	:
City	:	BEREA
State	:	OH
Zip	:	44017-3105
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12777 ROCKSIDE RD
Second Line	:
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125-4526
Country	:	US
Telephone Number	:	216-587-2943
Fax Number	:	216-587-4461

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

Provider Enumeration Date	:	01/04/2012
Last Update Date	:	01/04/2012

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