Healthcare Provider Details

I. General information

NPI: 1659469518
Provider Name (Legal Business Name): NAM PHUOC THANH NGUYEN PHARM. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 SERENO DR ONCOLOGY DEPARTMENT - MEDICINE 6
VALLEJO CA
94589-2441
US

IV. Provider business mailing address

4894 BUCKBOARD WAY
EL SOBRANTE CA
94803-3819
US

V. Phone/Fax

Practice location:
  • Phone: 707-651-2794
  • Fax: 707-651-4243
Mailing address:
  • Phone: 510-222-9164
  • Fax: 707-651-4243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number48525
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: