Healthcare Provider Details

I. General information

NPI: 1669947578
Provider Name (Legal Business Name): JONATHAN NGUYEN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2018
Last Update Date: 10/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 TIERRA REJADA RD
SIMI VALLEY CA
93065-2902
US

IV. Provider business mailing address

6333 CANOGA AVE APT 302
WOODLAND HILLS CA
91367-7708
US

V. Phone/Fax

Practice location:
  • Phone: 805-416-5791
  • Fax:
Mailing address:
  • Phone: 408-826-2489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number79521
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: