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General NPI Number Information
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NPI Number | 1013216175
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Entity Type | Individual
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Provider Name | HUONG DIEM-NGOC NGUYEN RPH
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Gender | Female
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Dates
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Enumeration Date | 03/15/2011
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Last Update Date | 03/15/2011
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Provider Practice Location Address
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Address Line | 2775 PORT SHELDON RD
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City | JENISON
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State | MI
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Zip | 49428-9359
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Country | US
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Telephone | 616-669-0970
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Fax | 616-662-0411
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Provider Business Mailing Address
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Address Line | 2775 PORT SHELDON RD
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City | JENISON
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State | MI
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Zip | 49428-9359
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Country | US
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Telephone | 616-669-0970
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Fax | 616-662-0411
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5302031453
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License Number State | MI
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