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General NPI Number Information
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NPI Number | 1982955514
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Entity Type | Individual
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Provider Name | LAM THANH NGUYEN
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Gender | Male
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Dates
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Enumeration Date | 09/22/2012
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Last Update Date | 09/22/2012
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Provider Practice Location Address
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Address Line | 10705 W INDIAN SCHOOL RD
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City | AVONDALE
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State | AZ
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Zip | 85392-5636
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Country | US
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Telephone | 623-877-3245
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Fax |
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Provider Business Mailing Address
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Address Line | 7100 W GRANDVIEW RD APT 1147
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City | PEORIA
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State | AZ
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Zip | 85382-4912
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Country | US
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Telephone | 626-277-6643
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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 | S019478
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License Number State | AZ
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