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General NPI Number Information
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NPI Number | 1497163083
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Entity Type | Individual
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Provider Name | MISS TAM T NGUYEN
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Gender | Female
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Dates
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Enumeration Date | 07/27/2014
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Last Update Date | 07/27/2014
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Provider Practice Location Address
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Address Line | 1120 S MOUNT VERNON AVE
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City | COLTON
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State | CA
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Zip | 92324-4220
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Country | US
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Telephone | 909-783-0390
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Fax | 909-783-7531
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Provider Business Mailing Address
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Address Line | 6544 ANGEL CAMP CT
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City | CORONA
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State | CA
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Zip | 92880-3263
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Country | US
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Telephone | 626-367-8114
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Fax | 909-783-7531
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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 | 56298
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License Number State | CA
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