Healthcare Provider Details

I. General information

NPI: 1720384399
Provider Name (Legal Business Name): PHUONG DANG NGUYEN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2011
Last Update Date: 01/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2106 TREASURE HILLS BLVD
HARLINGEN TX
78550-8736
US

IV. Provider business mailing address

3102 HAINE DR APT 7110
HARLINGEN TX
78550-0818
US

V. Phone/Fax

Practice location:
  • Phone: 956-366-4500
  • Fax:
Mailing address:
  • Phone: 714-642-1973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH 60892
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: