=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033394853
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BICHTRAM THI NGUYEN PHARMACIST
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/31/2007
-----------------------------------------------------
Last Update Date | 12/31/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9514 63RD AVE
-----------------------------------------------------
City | REGO PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11374
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-896-5084
-----------------------------------------------------
Fax | 718-896-1898
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5810 187TH ST
-----------------------------------------------------
City | FRESH MEADOWS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11365-2229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-357-8945
-----------------------------------------------------
Fax | 718-357-8945
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 047334
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------