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General NPI Number Information
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NPI Number | 1538830856
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Entity Type | Individual
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Provider Name | LISA NGUYEN
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Gender | Female
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Dates
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Enumeration Date | 09/26/2021
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Last Update Date | 09/28/2021
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Provider Practice Location Address
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Address Line | 4475 SAN JUAN AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32210-3357
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Country | US
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Telephone | 904-389-0314
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Fax |
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Provider Business Mailing Address
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Address Line | 4558 SAN LORENZO BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32224-3611
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Country | US
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Telephone | 904-993-0549
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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 | PS60721
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License Number State | FL
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