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General NPI Number Information
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NPI Number | 1760764856
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Entity Type | Individual
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Provider Name | BIC T NGUYEN
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Gender | Female
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Dates
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Enumeration Date | 09/14/2011
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Last Update Date | 09/14/2011
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Provider Practice Location Address
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Address Line | ROUTE 301 N 21 B AVENUE
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City | ZUNI
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State | NM
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Zip | 87327
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Country | US
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Telephone | 505-782-7518
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Fax |
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Provider Business Mailing Address
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Address Line | 215 MAPLE AVE
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City | GALLUP
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State | NM
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Zip | 87301
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Country | US
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Telephone |
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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 | RP442968
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License Number State | PA
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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 | RP00007214
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License Number State | NM
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