Healthcare Provider Details

I. General information

NPI: 1477195022
Provider Name (Legal Business Name): ALLEN QUOC NGUYEN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2019
Last Update Date: 10/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 MAIN ST
SWEET HOME OR
97386-3339
US

IV. Provider business mailing address

7724 SE 120TH PL
PORTLAND OR
97266-5077
US

V. Phone/Fax

Practice location:
  • Phone: 541-367-6777
  • Fax: 541-367-6500
Mailing address:
  • Phone: 503-784-4083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0017451
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: