Healthcare Provider Details

I. General information

NPI: 1891118261
Provider Name (Legal Business Name): CANG NGUYEN PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2014
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 E BASELINE RD
PHOENIX AZ
85042-6947
US

IV. Provider business mailing address

6924 S 19TH LN
PHOENIX AZ
85041-6653
US

V. Phone/Fax

Practice location:
  • Phone: 623-537-4591
  • Fax:
Mailing address:
  • Phone: 706-436-8781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS019415
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: