Healthcare Provider Details

I. General information

NPI: 1538313986
Provider Name (Legal Business Name): DIEP-ANH THI NGUYEN R.PH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2008
Last Update Date: 11/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 WINKLEY FARM LN
ROCHESTER NH
03867-4265
US

IV. Provider business mailing address

86 WINKLEY FARM LN
ROCHESTER NH
03867-4265
US

V. Phone/Fax

Practice location:
  • Phone: 603-755-2440
  • Fax: 603-755-9724
Mailing address:
  • Phone: 603-755-2440
  • Fax: 603-755-9724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberR1613
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: