Healthcare Provider Details

I. General information

NPI: 1083377170
Provider Name (Legal Business Name): LIEN NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2021
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2545 ARAMINGO AVE
PHILADELPHIA PA
19125-3728
US

IV. Provider business mailing address

5928 A ST
PHILA PA
19120-2004
US

V. Phone/Fax

Practice location:
  • Phone: 215-423-2361
  • Fax:
Mailing address:
  • Phone: 302-257-9155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP456273
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: