Healthcare Provider Details

I. General information

NPI: 1144145574
Provider Name (Legal Business Name): QUANG NGUYEN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 BACKLICK RD
ANNANDALE VA
22003-3142
US

IV. Provider business mailing address

4300 BACKLICK RD
ANNANDALE VA
22003-3142
US

V. Phone/Fax

Practice location:
  • Phone: 703-813-6050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202223806
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: