Healthcare Provider Details

I. General information

NPI: 1134047780
Provider Name (Legal Business Name): TAM TRI NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3720 E SUNSHINE ST
SPRINGFIELD MO
65809-2849
US

IV. Provider business mailing address

2920 S ELDON AVE
SPRINGFIELD MO
65807-5518
US

V. Phone/Fax

Practice location:
  • Phone: 417-437-2513
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number2023036778
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: