Healthcare Provider Details

I. General information

NPI: 1497534010
Provider Name (Legal Business Name): NGUYEN THI BAO NGUYEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2023
Last Update Date: 09/22/2023
Certification Date: 09/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1268 MADERA RD
SIMI VALLEY CA
93065-4002
US

IV. Provider business mailing address

12448 DENALI CT
MOORPARK CA
93021-0903
US

V. Phone/Fax

Practice location:
  • Phone: 805-520-0760
  • Fax:
Mailing address:
  • Phone: 714-949-9656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH88579
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: