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General NPI Number Information
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NPI Number | 1447242516
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Entity Type | Individual
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Provider Name | TAM HOANG NGUYEN
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Gender | Male
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Dates
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Enumeration Date | 08/16/2005
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Last Update Date | 01/22/2008
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Provider Practice Location Address
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Address Line | 7240 E SOUTHGATE DR SUITE # A
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City | SACRAMENTO
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State | CA
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Zip | 95823-2627
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Country | US
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Telephone | 916-393-5961
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Fax |
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Provider Business Mailing Address
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Address Line | 7240 E SOUTHGATE DR SUITE # A
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City | SACRAMENTO
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State | CA
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Zip | 95823-2627
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Country | US
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Telephone | 916-393-5961
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHA378430
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License Number State | CA
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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 | RPH42362
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License Number State | CA
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