MEDICARE: THUY NGOC NGUYEN

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	051.289250	IL

General Provider Information

NPI Number	:	1982987236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THUY NGOC NGUYEN

Provider Business Mailing Address
First Line	:	1504 FOWLER AVE
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-3955
Country	:	US
Telephone Number	:	847-905-0766
Fax Number	:

Provider Business Practice Location Address
First Line	:	3358 N WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-6213
Country	:	US
Telephone Number	:	773-327-2111
Fax Number	:	773-327-0859

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

Provider Enumeration Date	:	09/22/2011
Last Update Date	:	09/22/2011

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Directions to “ THUY NGOC NGUYEN ” Practice Location

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