=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003779877
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROGER NGUYEN RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2025
-----------------------------------------------------
Last Update Date | 12/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20220 N 59TH AVE
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85308-6844
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-825-3311
-----------------------------------------------------
Fax | 623-825-3344
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20420 N 53RD AVE
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85308-9345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-466-4646
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | S027796
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------