Healthcare Provider Details

I. General information

NPI: 1982987236
Provider Name (Legal Business Name): THUY NGOC NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2011
Last Update Date: 09/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3358 N WESTERN AVE
CHICAGO IL
60618-6213
US

IV. Provider business mailing address

1504 FOWLER AVE
EVANSTON IL
60201-3955
US

V. Phone/Fax

Practice location:
  • Phone: 773-327-2111
  • Fax: 773-327-0859
Mailing address:
  • Phone: 847-905-0766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.289250
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: