Healthcare Provider Details

I. General information

NPI: 1871400622
Provider Name (Legal Business Name): JARVIS NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18611 EASTFIELD DR
WEBSTER TX
77598-1303
US

IV. Provider business mailing address

959 RICHVALE LN
HOUSTON TX
77062-4327
US

V. Phone/Fax

Practice location:
  • Phone: 281-488-0179
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number30253279
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: