Healthcare Provider Details

I. General information

NPI: 1124336813
Provider Name (Legal Business Name): DONNI H NGUYEN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2010
Last Update Date: 09/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 W BROAD ST
FALLS CHURCH VA
22046-4610
US

IV. Provider business mailing address

6124 MADISON CREST CT
FALLS CHURCH VA
22041-3653
US

V. Phone/Fax

Practice location:
  • Phone: 703-241-5031
  • Fax: 703-241-5037
Mailing address:
  • Phone: 703-845-2832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202206458
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: