Healthcare Provider Details

I. General information

NPI: 1770795684
Provider Name (Legal Business Name): KIM NGUYEN ARCERITO PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 GLEN COVE AVE
GLEN COVE NY
11542-4191
US

IV. Provider business mailing address

206 GLEN COVE AVE
GLEN COVE NY
11542-4191
US

V. Phone/Fax

Practice location:
  • Phone: 516-676-1334
  • Fax:
Mailing address:
  • Phone: 516-676-1334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13484
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number072746-01
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number46455
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302040391
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: