Healthcare Provider Details

I. General information

NPI: 1003796517
Provider Name (Legal Business Name): BRIAN NGUYEN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 X ST, SACRAMENTO, CA 95817
SACRAMENTO CA
95817-2202
US

IV. Provider business mailing address

2300 STOCKTON BLVD
SACRAMENTO CA
95817-2202
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-2011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH91058
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: