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General NPI Number Information
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NPI Number | 1124776422
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Entity Type | Individual
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Provider Name | TAM VAN NGUYEN
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Gender | Male
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Dates
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Enumeration Date | 03/15/2022
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Last Update Date | 03/15/2022
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Provider Practice Location Address
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Address Line | 7650 W SAND LAKE RD
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City | ORLANDO
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State | FL
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Zip | 32819-5112
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Country | US
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Telephone | 407-370-6742
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Fax |
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Provider Business Mailing Address
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Address Line | 921 WHISPERING CYPRESS LN
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City | ORLANDO
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State | FL
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Zip | 32824-5274
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Country | US
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Telephone | 407-616-8523
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Fax |
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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 | PS34329
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License Number State | FL
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