Healthcare Provider Details

I. General information

NPI: 1962060079
Provider Name (Legal Business Name): NHIEN MY LUC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 06/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 LONG BEACH BLVD
LONG BEACH CA
90805-6317
US

IV. Provider business mailing address

12082 MYRON TRAPP DR
GARDEN GROVE CA
92840-3362
US

V. Phone/Fax

Practice location:
  • Phone: 562-984-2813
  • Fax:
Mailing address:
  • Phone: 714-260-3302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number63042
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: