=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275044927
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREW TAI NGUYEN RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2017
-----------------------------------------------------
Last Update Date | 10/21/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 815 CANYON DEL REY BLVD
-----------------------------------------------------
City | DEL REY OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93940-5525
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-393-2104
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 GLENWOOD CIR APT 171
-----------------------------------------------------
City | MONTEREY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93940-4708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-480-1571
-----------------------------------------------------
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 | 77704
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------