Healthcare Provider Details

I. General information

NPI: 1326661653
Provider Name (Legal Business Name): MYLE THI NGUYEN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2020
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 LANDMARK DR
RALEIGH NC
27607-6524
US

IV. Provider business mailing address

2411 LANDMARK DR
RALEIGH NC
27607-6524
US

V. Phone/Fax

Practice location:
  • Phone: 918-788-4203
  • Fax:
Mailing address:
  • Phone: 918-788-4203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number34192
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberPI63990
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH241380
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: