Healthcare Provider Details

I. General information

NPI: 1568376739
Provider Name (Legal Business Name): RANDY NGUYEN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8717 E FAIRVIEW AVE
SAN GABRIEL CA
91775-1207
US

IV. Provider business mailing address

8717 E FAIRVIEW AVE
SAN GABRIEL CA
91775-1207
US

V. Phone/Fax

Practice location:
  • Phone: 626-872-8029
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number93166
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: