Healthcare Provider Details

I. General information

NPI: 1063123503
Provider Name (Legal Business Name): NGUYET DANG MINH DO PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26520 MAPLE VALLEY BLACK DIAMOND RD SE
MAPLE VALLEY WA
98038-8394
US

IV. Provider business mailing address

26520 MAPLE VALLEY BLACK DIAMOND RD SE
MAPLE VALLEY WA
98038-8394
US

V. Phone/Fax

Practice location:
  • Phone: 425-433-2333
  • Fax: 425-433-2327
Mailing address:
  • Phone: 425-433-2333
  • Fax: 425-433-2327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPH61312375
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH61312375
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: