Healthcare Provider Details

I. General information

NPI: 1093630162
Provider Name (Legal Business Name): TANDREW NGUYEN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CVS DR
WOONSOCKET RI
02895-6146
US

IV. Provider business mailing address

6954 GOVERNORS POINT DR
INDIANAPOLIS IN
46217-8508
US

V. Phone/Fax

Practice location:
  • Phone: 401-765-1500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26032196A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: