Healthcare Provider Details

I. General information

NPI: 1275059495
Provider Name (Legal Business Name): KIM NGUYEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2017
Last Update Date: 09/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5305 W BUCKEYE RD STE B
PHOENIX AZ
85043-4727
US

IV. Provider business mailing address

7455 W CACTUS ROAD
PEORIA AZ
85381
US

V. Phone/Fax

Practice location:
  • Phone: 602-442-9008
  • Fax:
Mailing address:
  • Phone: 623-486-0441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS022684
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: