Healthcare Provider Details

I. General information

NPI: 1689841355
Provider Name (Legal Business Name): JENNY PHUONG NGUYEN PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 SWEETWATER RD
SPRING VALLEY CA
91977-5628
US

IV. Provider business mailing address

661 SWEETWATER RD
SPRING VALLEY CA
91977-5628
US

V. Phone/Fax

Practice location:
  • Phone: 619-463-9848
  • Fax: 619-463-9628
Mailing address:
  • Phone: 619-463-9848
  • Fax: 619-463-9628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number56529
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: