Healthcare Provider Details

I. General information

NPI: 1275253288
Provider Name (Legal Business Name): HIEN BAO NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6470 S HIGLEY RD
GILBERT AZ
85298-4333
US

IV. Provider business mailing address

6470 S HIGLEY RD
GILBERT AZ
85298-4333
US

V. Phone/Fax

Practice location:
  • Phone: 480-840-9562
  • Fax: 480-840-9563
Mailing address:
  • Phone: 480-840-9562
  • Fax: 480-840-9563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS026001
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: