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General NPI Number Information
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NPI Number | 1497313100
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Entity Type | Individual
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Provider Name | TINA NGUYEN
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Gender | Female
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Dates
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Enumeration Date | 05/29/2019
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Last Update Date | 05/29/2019
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Provider Practice Location Address
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Address Line | 1301 CENTER DR
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City | MEDFORD
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State | OR
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Zip | 97501-7938
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Country | US
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Telephone | 541-857-4650
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Fax |
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Provider Business Mailing Address
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Address Line | 3815 SE 122ND AVE APT 8
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City | PORTLAND
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State | OR
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Zip | 97236-3759
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Country | US
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Telephone | 503-473-5292
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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 | RPH-0017123
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License Number State | OR
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