Healthcare Provider Details

I. General information

NPI: 1568779320
Provider Name (Legal Business Name): PHUONG-QUYNH LY NGUYEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2010
Last Update Date: 08/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 S MILDRED ST
TACOMA WA
98465-1608
US

IV. Provider business mailing address

1850 S MILDRED ST
TACOMA WA
98465-1608
US

V. Phone/Fax

Practice location:
  • Phone: 253-460-9599
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60107540
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: