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: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3421 W THUNDERBIRD RD
PHOENIX AZ
85053-5602
US

IV. Provider business mailing address

20420 N 53RD AVE
GLENDALE AZ
85308-9345
US

V. Phone/Fax

Practice location:
  • Phone: 602-375-0193
  • Fax: 602-852-0936
Mailing address:
  • Phone: 623-466-4646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS027796
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: