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General NPI Number Information
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NPI Number | 1447563895
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Entity Type | Individual
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Provider Name | MR. JASON BAO NGHIEM
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Gender | Male
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Dates
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Enumeration Date | 07/14/2010
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Last Update Date | 07/14/2010
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Provider Practice Location Address
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Address Line | 2419 E AVENUE S
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City | PALMDALE
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State | CA
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Zip | 93550-6202
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Country | US
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Telephone | 661-274-4333
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Fax | 661-274-8015
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Provider Business Mailing Address
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Address Line | 41463 ALEXO DR
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City | LANCASTER
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State | CA
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Zip | 93536-2333
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Country | US
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Telephone | 714-932-7330
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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 | 57948
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License Number State | CA
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