Healthcare Provider Details

I. General information

NPI: 1770186694
Provider Name (Legal Business Name): DANNY NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2020
Last Update Date: 11/21/2020
Certification Date: 11/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8872 COLUMBIA RD
MAINEVILLE OH
45039-9479
US

IV. Provider business mailing address

8872 COLUMBIA RD
MAINEVILLE OH
45039-9479
US

V. Phone/Fax

Practice location:
  • Phone: 513-677-1222
  • Fax: 513-677-1646
Mailing address:
  • Phone: 513-677-1222
  • Fax: 513-677-1646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03325428
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: