Healthcare Provider Details

I. General information

NPI: 1669771424
Provider Name (Legal Business Name): QUYEN T NGUYEN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2011
Last Update Date: 03/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3209 KIRKWOOD HWY
WILMINGTON DE
19808-6129
US

IV. Provider business mailing address

102 PARRISH LN
WILMINGTON DE
19810-3456
US

V. Phone/Fax

Practice location:
  • Phone: 302-995-6124
  • Fax: 302-995-0630
Mailing address:
  • Phone: 302-345-5205
  • Fax: 302-995-0630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP044085L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberA1-0002926
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: