Healthcare Provider Details

I. General information

NPI: 1003779877
Provider Name (Legal Business Name): ROGER NGUYEN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20220 N 59TH AVE
GLENDALE AZ
85308-6844
US

IV. Provider business mailing address

20420 N 53RD AVE
GLENDALE AZ
85308-9345
US

V. Phone/Fax

Practice location:
  • Phone: 623-825-3311
  • Fax: 623-825-3344
Mailing address:
  • Phone: 623-466-4646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS027796
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: