Healthcare Provider Details

I. General information

NPI: 1306752936
Provider Name (Legal Business Name): JAMES NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2026
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 W EL CAMINO ALTO ST
SPRINGFIELD MO
65810-4719
US

IV. Provider business mailing address

545 W EL CAMINO ALTO ST
SPRINGFIELD MO
65810-4719
US

V. Phone/Fax

Practice location:
  • Phone: 417-414-6621
  • Fax:
Mailing address:
  • Phone: 417-414-6621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number2023035700
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: