Healthcare Provider Details

I. General information

NPI: 1790077840
Provider Name (Legal Business Name): TAMMY NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2011
Last Update Date: 05/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20225 SW TUALATIN VALLEY HWY
ALOHA OR
97006-2302
US

IV. Provider business mailing address

18305 NE 20TH ST
VANCOUVER WA
98684-9803
US

V. Phone/Fax

Practice location:
  • Phone: 503-649-1576
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH-0010350
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: