Healthcare Provider Details

I. General information

NPI: 1467050682
Provider Name (Legal Business Name): VICKIE NGUYEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2020
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 EL CAMINO REAL
SOUTH SAN FRANCISCO CA
94080-3208
US

IV. Provider business mailing address

615 GAMMA CT APT C
CAMPBELL CA
95008-5224
US

V. Phone/Fax

Practice location:
  • Phone: 650-742-2000
  • Fax:
Mailing address:
  • Phone: 813-598-6515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number84661
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: