Healthcare Provider Details

I. General information

NPI: 1689279218
Provider Name (Legal Business Name): MYDUY NGUYEN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2020
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5202 MURFREESBORO RD
LA VERGNE TN
37086-2714
US

IV. Provider business mailing address

5202 MURFREESBORO RD
LA VERGNE TN
37086-2714
US

V. Phone/Fax

Practice location:
  • Phone: 615-793-3784
  • Fax: 615-213-2544
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number39458
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: