Healthcare Provider Details

I. General information

NPI: 1669075578
Provider Name (Legal Business Name): VICTORIA THAO NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2020
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 N MILWAUKEE AVE
VERNON HILLS IL
60061-1538
US

IV. Provider business mailing address

2984 ACORN LN
NORTHBROOK IL
60062-3334
US

V. Phone/Fax

Practice location:
  • Phone: 847-816-3247
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number051302397
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: