=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124939038
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | QUYNHTRAM NGUYEN PHARMD, MS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2026
-----------------------------------------------------
Last Update Date | 09/17/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1405 JEFFERSON HWY STE A
-----------------------------------------------------
City | JEFFERSON
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70121-2448
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-931-8177
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 701 THIRBA ST
-----------------------------------------------------
City | METAIRIE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70003-6333
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-931-8177
-----------------------------------------------------
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 | PST.026357
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------