Healthcare Provider Details

I. General information

NPI: 1396966727
Provider Name (Legal Business Name): THU T NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9920 BUSTLETON AVE
PHILADELPHIA PA
19115-2149
US

IV. Provider business mailing address

7141 HORROCKS ST
PHILADELPHIA PA
19149-1210
US

V. Phone/Fax

Practice location:
  • Phone: 215-464-1177
  • Fax: 215-464-4953
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP441238
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: