Healthcare Provider Details

I. General information

NPI: 1508941022
Provider Name (Legal Business Name): VUONG Q NGUYEN PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 W YOSEMITE AVE
MANTECA CA
95337-5187
US

IV. Provider business mailing address

1330 COMO DR
MANTECA CA
95337-8471
US

V. Phone/Fax

Practice location:
  • Phone: 209-406-9944
  • Fax: 209-825-3617
Mailing address:
  • Phone: 209-406-9944
  • Fax: 209-825-3617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberRPH 46719
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: