Healthcare Provider Details

I. General information

NPI: 1902351885
Provider Name (Legal Business Name): CASEY DAN NGUYEN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2016
Last Update Date: 08/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 W APACHE TRL
APACHE JUNCTION AZ
85120-3412
US

IV. Provider business mailing address

1849 S POWER RD #1197
MESA AZ
85206-4332
US

V. Phone/Fax

Practice location:
  • Phone: 602-732-3384
  • Fax:
Mailing address:
  • Phone: 480-204-6608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS022093
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: