Healthcare Provider Details

I. General information

NPI: 1740779115
Provider Name (Legal Business Name): JAMIE DONG VIET NGUYEN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2018
Last Update Date: 03/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 HOYT AVE
EVERETT WA
98201
US

IV. Provider business mailing address

PO BOX 5127
EVERETT WA
98206-5127
US

V. Phone/Fax

Practice location:
  • Phone: 425-317-3944
  • Fax: 425-317-3931
Mailing address:
  • Phone: 425-317-3944
  • Fax: 425-317-3931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60748647
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: