Healthcare Provider Details

I. General information

NPI: 1215210620
Provider Name (Legal Business Name): EMILY QUYNH NGUYEN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2011
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 W LAKE MEAD BLVD
LAS VEGAS NV
89108-2660
US

IV. Provider business mailing address

6101 W LAKE MEAD BLVD
LAS VEGAS NV
89108-2660
US

V. Phone/Fax

Practice location:
  • Phone: 702-648-2732
  • Fax:
Mailing address:
  • Phone: 702-648-2732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number17599
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number17599
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number17599
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: