Healthcare Provider Details

I. General information

NPI: 1174404297
Provider Name (Legal Business Name): THU HANG NGUYEN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY NGUYEN

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25105 S ELLSWORTH RD
QUEEN CREEK AZ
85142-1563
US

IV. Provider business mailing address

25105 S ELLSWORTH RD
QUEEN CREEK AZ
85142-1563
US

V. Phone/Fax

Practice location:
  • Phone: 480-428-7616
  • Fax: 480-428-7617
Mailing address:
  • Phone: 480-428-7616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS027618
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: