MEDICARE: QUYNH-GIAO THY NGUYEN PHARM D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P2201X	Ambulatory Care Pharmacist	PH00055127	WA

General Provider Information

NPI Number	:	1033698410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QUYNH-GIAO THY NGUYEN PHARM D

Provider Business Mailing Address
First Line	:	1002 15TH ST SW
Second Line	:
City	:	AUBURN
State	:	WA
Zip	:	98001-6502
Country	:	US
Telephone Number	:	253-876-8657
Fax Number	:

Provider Business Practice Location Address
First Line	:	1002 15TH ST SW
Second Line	:
City	:	AUBURN
State	:	WA
Zip	:	98001-6502
Country	:	US
Telephone Number	:	253-876-8657
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2018
Last Update Date	:	08/07/2018

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