Healthcare Provider Details

I. General information

NPI: 1619882149
Provider Name (Legal Business Name): KEVIN NGUYEN VU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9025 SPENCER HWY
LA PORTE TX
77571-3870
US

IV. Provider business mailing address

10611 KATYA GILLIAN DR
HOUSTON TX
77034-3877
US

V. Phone/Fax

Practice location:
  • Phone: 281-479-9364
  • Fax:
Mailing address:
  • Phone: 346-247-4946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number77696
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: