Healthcare Provider Details

I. General information

NPI: 1912801911
Provider Name (Legal Business Name): KELLY VY NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17049 W BELL RD
SURPRISE AZ
85374-2976
US

IV. Provider business mailing address

13213 W JACOBSON DR
LITCHFIELD PARK AZ
85340-5392
US

V. Phone/Fax

Practice location:
  • Phone: 623-518-1059
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS028122
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: