Healthcare Provider Details

I. General information

NPI: 1730460817
Provider Name (Legal Business Name): THANH DAI NGUYEN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2011
Last Update Date: 09/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 GILMAN ST
BERKELEY CA
94710-1532
US

IV. Provider business mailing address

1050 GILMAN ST
BERKELEY CA
94710-1532
US

V. Phone/Fax

Practice location:
  • Phone: 510-528-8274
  • Fax: 510-528-8659
Mailing address:
  • Phone: 510-528-8274
  • Fax: 510-528-8659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH53526
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: