Healthcare Provider Details

I. General information

NPI: 1730999756
Provider Name (Legal Business Name): KATHY AMELIA NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2025
Last Update Date: 01/11/2025
Certification Date: 01/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9910 FRANKFORD AVE STE 250
PHILA PA
19114-1963
US

IV. Provider business mailing address

601 PRINCETON AVE
PHILADELPHIA PA
19111-4029
US

V. Phone/Fax

Practice location:
  • Phone: 215-824-2700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP458844
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: