Healthcare Provider Details

I. General information

NPI: 1053167346
Provider Name (Legal Business Name): ANGEL XUAN-NGUYEN BUI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2024
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3451 HERITAGE TRACE PKWY
FORT WORTH TX
76177-7505
US

IV. Provider business mailing address

3451 HERITAGE TRACE PKWY
FORT WORTH TX
76177-7505
US

V. Phone/Fax

Practice location:
  • Phone: 817-232-8632
  • Fax: 682-708-1783
Mailing address:
  • Phone: 817-232-8632
  • Fax: 682-708-1783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number297859
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: