Healthcare Provider Details

I. General information

NPI: 1508054750
Provider Name (Legal Business Name): LY NGUYEN PHARM.D.,BCPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 07/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 W 8TH ST DEPARTMENT OF PHARMACY
JACKSONVILLE FL
32209-6511
US

IV. Provider business mailing address

655 W 8TH ST DEPARTMENT OF PHARMACY
JACKSONVILLE FL
32209-6511
US

V. Phone/Fax

Practice location:
  • Phone: 904-244-0354
  • Fax:
Mailing address:
  • Phone: 904-244-0354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12664
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPS47270
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: