Healthcare Provider Details

I. General information

NPI: 1194016568
Provider Name (Legal Business Name): THACH NGUYEN PHARM D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 04/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 N WILSON WAY
STOCKTON CA
95205-4218
US

IV. Provider business mailing address

1050 N WILSON WAY
STOCKTON CA
95205-4218
US

V. Phone/Fax

Practice location:
  • Phone: 209-948-0950
  • Fax: 209-948-6539
Mailing address:
  • Phone: 209-948-0950
  • Fax: 209-948-6539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number56330
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: