Healthcare Provider Details

I. General information

NPI: 1720326101
Provider Name (Legal Business Name): DAVID M NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2013
Last Update Date: 01/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 E SILVER STAR RD
OCOEE FL
34761-7014
US

IV. Provider business mailing address

1720 E SILVER STAR RD
OCOEE FL
34761-7014
US

V. Phone/Fax

Practice location:
  • Phone: 407-522-2774
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS34482
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: