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General NPI Number Information
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NPI Number | 1356820575
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Entity Type | Individual
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Provider Name | PHONG T NGUYEN PHARMD
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Gender | Male
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Dates
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Enumeration Date | 08/08/2018
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Last Update Date | 08/08/2018
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Provider Practice Location Address
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Address Line | 6002 N 7TH ST
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City | PHOENIX
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State | AZ
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Zip | 85014-1801
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Country | US
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Telephone | 602-728-0437
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Fax |
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Provider Business Mailing Address
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Address Line | 6147 N 19TH AVE
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City | PHOENIX
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State | AZ
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Zip | 85015-2108
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Country | US
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Telephone | 480-540-3145
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Fax |
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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 | S023432
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License Number State | AZ
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