Healthcare Provider Details

I. General information

NPI: 1588816615
Provider Name (Legal Business Name): CAROLYN THAO NGUYEN PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 N. LAKEVIEW AVE
ANAHEIM CA
92807
US

IV. Provider business mailing address

1305 SUN DIAL DRIVE
TUSTIN CA
92782
US

V. Phone/Fax

Practice location:
  • Phone: 714-279-4174
  • Fax:
Mailing address:
  • Phone: 626-380-6633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number58613
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: