Healthcare Provider Details

I. General information

NPI: 1578489282
Provider Name (Legal Business Name): TRACY THANH NGUYEN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 WILMOT RD
DEERFIELD IL
60015-5145
US

IV. Provider business mailing address

108 WILMOT RD
DEERFIELD IL
60015-5145
US

V. Phone/Fax

Practice location:
  • Phone: 877-924-4472
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number50386
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: