Healthcare Provider Details

I. General information

NPI: 1750794780
Provider Name (Legal Business Name): AMANDA NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2014
Last Update Date: 06/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 CANTON RD
AKRON OH
44312-4043
US

IV. Provider business mailing address

1540 CANTON RD
AKRON OH
44312-4043
US

V. Phone/Fax

Practice location:
  • Phone: 330-733-8378
  • Fax: 330-733-3978
Mailing address:
  • Phone: 330-733-8378
  • Fax: 330-733-3978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03222470
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: