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General NPI Number Information
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NPI Number | 1801379425
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Entity Type | Individual
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Provider Name | KEVIN NGUYEN
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Gender | Male
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Dates
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Enumeration Date | 09/10/2018
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Last Update Date | 09/10/2018
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Provider Practice Location Address
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Address Line | 5575 BYRON CENTER AVE SW
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City | WYOMING
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State | MI
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Zip | 49519-9603
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Country | US
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Telephone | 616-534-5175
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Fax |
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Provider Business Mailing Address
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Address Line | 6162 ARROWCREST CT NE
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City | ROCKFORD
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State | MI
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Zip | 49341-7368
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Country | US
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Telephone | 616-951-2775
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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 | 5302042830
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License Number State | MI
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