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NPI Code Detail

MEDICARE: TIN THI NGOC NGUYEN PHARM.D

MEDICARE: TIN THI NGOC NGUYEN PHARM.D
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
1183500000XPharmacist79057CA

General Provider Information

NPI Number : 1952872442
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIN THI NGOC NGUYEN PHARM.D
Provider Business Mailing Address
First Line : 15 W HARDING WAY
Second Line :
City : STOCKTON
State : CA
Zip : 95204-5716
Country : US
Telephone Number : 209-941-9632
Fax Number :
Provider Business Practice Location Address
First Line : 15 W HARDING WAY
Second Line :
City : STOCKTON
State : CA
Zip : 95204-5716
Country : US
Telephone Number : 209-941-9632
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/10/2018
Last Update Date : 12/10/2018

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