Healthcare Provider Details

I. General information

NPI: 1053463653
Provider Name (Legal Business Name): CHI LIEU NGUYEN PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 06/20/2022
Certification Date: 06/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5026 FRUITRIDGE RD STE 3
SACRAMENTO CA
95820-5302
US

IV. Provider business mailing address

5026 FRUITRIDGE RD STE 3
SACRAMENTO CA
95820-5302
US

V. Phone/Fax

Practice location:
  • Phone: 916-469-9813
  • Fax: 916-469-9874
Mailing address:
  • Phone: 916-469-9813
  • Fax: 916-469-9874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberRPH46977
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number51051
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: