Healthcare Provider Details

I. General information

NPI: 1447925094
Provider Name (Legal Business Name): POLLY NGUYEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2021
Last Update Date: 01/05/2022
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9715 OTIS ST
SOUTH GATE CA
90280-4931
US

IV. Provider business mailing address

9715 OTIS ST
SOUTH GATE CA
90280-4931
US

V. Phone/Fax

Practice location:
  • Phone: 323-566-1198
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number84659
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: