MEDICARE: KIMNGA THI 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	PH23325	MA

General Provider Information

NPI Number	:	1871875096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMNGA THI NGUYEN RPH

Provider Business Mailing Address
First Line	:	179 COLEMAN ST
Second Line	:
City	:	MALDEN
State	:	MA
Zip	:	02148-4503
Country	:	US
Telephone Number	:	781-322-6804
Fax Number	:

Provider Business Practice Location Address
First Line	:	343 BROADWAY
Second Line	:
City	:	SOMERVILLE
State	:	MA
Zip	:	02145-2407
Country	:	US
Telephone Number	:	617-776-5104
Fax Number	:	617-776-7591

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

Provider Enumeration Date	:	09/13/2011
Last Update Date	:	09/13/2011

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