=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043813405
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | QUY NGUYEN RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/18/2020
-----------------------------------------------------
Last Update Date | 11/18/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1200 W MAIN ST
-----------------------------------------------------
City | GUN BARREL CITY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75156-5320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-887-2133
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6002 HARWOOD CROSSING DR
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76018-3153
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-241-4818
-----------------------------------------------------
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 | 61517
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------