Healthcare Provider Details

I. General information

NPI: 1134349574
Provider Name (Legal Business Name): PATRICIA TUYET SAGADIEV RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICIA TUYET NGUYEN

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 07/12/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 E 2ND ST
PORT ANGELES WA
98362-3119
US

IV. Provider business mailing address

1210 E 2ND ST
POST ANGELES WA
98362
US

V. Phone/Fax

Practice location:
  • Phone: 360-452-4200
  • Fax:
Mailing address:
  • Phone: 301-807-4016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16248
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18609
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60568836
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: