=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235603523
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PHUONG THAO NGUYEN PHARM.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2019
-----------------------------------------------------
Last Update Date | 01/19/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4400 E LOS COYOTES DIAGONAL
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90815-2819
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-494-4282
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8841 MCFADDEN AVE
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92683-6841
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-797-5477
-----------------------------------------------------
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 | 79184
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------