Healthcare Provider Details

I. General information

NPI: 1962695130
Provider Name (Legal Business Name): MICHELLE V NGUYEN PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 W BRAKER LN
AUSTIN TX
78758-3801
US

IV. Provider business mailing address

1210 W BRAKER LN
AUSTIN TX
78758-3801
US

V. Phone/Fax

Practice location:
  • Phone: 512-978-9634
  • Fax:
Mailing address:
  • Phone: 512-978-9634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number45562
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: