Healthcare Provider Details

I. General information

NPI: 1154212801
Provider Name (Legal Business Name): VAN NGUYEN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2025
Last Update Date: 07/12/2025
Certification Date: 07/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 WILSON TERRACE INPATIENT PHARMACY DEPARTMENT
GLENDALE CA
91206
US

IV. Provider business mailing address

PO BOX 26182
SANTA ANA CA
92799-6182
US

V. Phone/Fax

Practice location:
  • Phone: 818-409-8183
  • Fax:
Mailing address:
  • Phone: 818-409-8183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number79309
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: