Healthcare Provider Details

I. General information

NPI: 1083295950
Provider Name (Legal Business Name): SON QUOC NGUYEN PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 CORTARO DR
SUN CITY CENTER FL
33573-6812
US

IV. Provider business mailing address

765 CORTARO DR
SUN CITY CENTER FL
33573-6812
US

V. Phone/Fax

Practice location:
  • Phone: 813-551-2999
  • Fax: 813-922-4155
Mailing address:
  • Phone: 813-551-2999
  • Fax: 813-922-4155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberPS55752
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: