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General NPI Number Information
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NPI Number | 1265642656
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Entity Type | Individual
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Provider Name | PHUONG THAO THI NGUYEN
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Gender | Female
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4828 READING ST
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City | DALLAS
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State | TX
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Zip | 75247-6705
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Country | US
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Telephone | 214-630-0333
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Fax | 214-630-0473
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Provider Business Mailing Address
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Address Line | 3503 UNIVERSITY PARK LN
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City | IRVING
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State | TX
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Zip | 75062-6590
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Country | US
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Telephone | 972-650-0979
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Fax | 214-630-0473
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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 | 37311
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 12509
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License Number State | OK
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