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General NPI Number Information
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NPI Number | 1558642942
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Entity Type | Individual
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Provider Name | MYA THAO NGUYEN
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Gender | Female
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Dates
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Enumeration Date | 08/30/2011
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Last Update Date | 01/05/2023
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Provider Practice Location Address
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Address Line | 4850 OAKTON ST
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City | SKOKIE
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State | IL
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Zip | 60077-2953
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Country | US
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Telephone | 847-933-0418
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Fax | 847-933-0418
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Provider Business Mailing Address
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Address Line | 921 LARAMIE AVE
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City | GLENVIEW
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State | IL
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Zip | 60025-3350
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Country | US
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Telephone | 708-369-3386
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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 | 051291588
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051-291588
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License Number State | IL
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