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General NPI Number Information
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NPI Number | 1477195022
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Entity Type | Individual
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Provider Name | ALLEN QUOC NGUYEN PHARMD
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Gender | Male
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Dates
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Enumeration Date | 10/15/2019
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Last Update Date | 10/15/2019
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Provider Practice Location Address
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Address Line | 621 MAIN ST
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City | SWEET HOME
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State | OR
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Zip | 97386-3339
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Country | US
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Telephone | 541-367-6777
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Fax | 541-367-6500
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Provider Business Mailing Address
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Address Line | 7724 SE 120TH PL
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City | PORTLAND
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State | OR
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Zip | 97266-5077
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Country | US
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Telephone | 503-784-4083
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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 | 0017451
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License Number State | OR
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