=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285655258
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TUAN NGUYEN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2006
-----------------------------------------------------
Last Update Date | 10/14/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 512 ELLIS ST
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94109-8103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-441-2672
-----------------------------------------------------
Fax | 415-441-2763
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 512 ELLIS ST
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94109-8103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-441-2672
-----------------------------------------------------
Fax | 415-441-2763
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER PHARMACIST
-----------------------------------------------------
Name | TUAN NGUYEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 415-441-2672
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PHY40568
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------