Healthcare Provider Details

I. General information

NPI: 1639092158
Provider Name (Legal Business Name): PHILIP NGUYEN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2026
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BLYTHE BLVD
CHARLOTTE NC
28203-5812
US

IV. Provider business mailing address

5621 GLEN FOREST DR
CHARLOTTE NC
28226-8137
US

V. Phone/Fax

Practice location:
  • Phone: 704-355-5837
  • Fax:
Mailing address:
  • Phone: 704-796-8019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12808
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: