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General NPI Number Information
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NPI Number | 1962929356
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Entity Type | Individual
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Provider Name | TRUC JESSICA NGUYEN
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Gender | Female
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Dates
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Enumeration Date | 08/25/2017
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Last Update Date | 08/25/2017
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Provider Practice Location Address
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Address Line | 3130 PONTCHARTRAIN DR
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City | SLIDELL
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State | LA
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Zip | 70458-4644
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Country | US
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Telephone | 985-288-6523
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Fax |
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Provider Business Mailing Address
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Address Line | 11420 TANNER S DAVIS DR
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City | NEW ORLEANS
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State | LA
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Zip | 70128-5214
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Country | US
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Telephone | 504-710-8750
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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 | PST.022165
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License Number State | LA
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