Healthcare Provider Details

I. General information

NPI: 1740580034
Provider Name (Legal Business Name): KHANG NGUYEN NGUYEN PHARM. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20797 N JOHN WAYNE PKWY
MARICOPA AZ
85139-5575
US

IV. Provider business mailing address

20797 N JOHN WAYNE PKWY
MARICOPA AZ
85139-5575
US

V. Phone/Fax

Practice location:
  • Phone: 520-568-6233
  • Fax: 520-568-6227
Mailing address:
  • Phone: 520-568-6233
  • Fax: 520-568-6227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS013435
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: