Healthcare Provider Details

I. General information

NPI: 1447242516
Provider Name (Legal Business Name): TAM HOANG NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7240 E SOUTHGATE DR SUITE # A
SACRAMENTO CA
95823-2627
US

IV. Provider business mailing address

7240 E SOUTHGATE DR SUITE # A
SACRAMENTO CA
95823-2627
US

V. Phone/Fax

Practice location:
  • Phone: 916-393-5961
  • Fax:
Mailing address:
  • Phone: 916-393-5961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH42362
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHA378430
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: