Healthcare Provider Details

I. General information

NPI: 1518890102
Provider Name (Legal Business Name): TIM NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12425 HAGEN RANCH RD
BOYNTON BEACH FL
33437-4107
US

IV. Provider business mailing address

1645 RENAISSANCE COMMONS BLVD APT 1417
BOYNTON BEACH FL
33426-8352
US

V. Phone/Fax

Practice location:
  • Phone: 561-292-4494
  • Fax:
Mailing address:
  • Phone: 561-523-9450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPSI47116
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: