=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710505383
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BILLY NGUYEN PHARMACIST
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2020
-----------------------------------------------------
Last Update Date | 07/10/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 944 GLENNEYRE ST
-----------------------------------------------------
City | LAGUNA BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92651-2717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-494-6585
-----------------------------------------------------
Fax | 949-497-8679
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7515 21ST ST APT C
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92683-3941
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-900-0234
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 48561
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------