MEDICARE: LISA NGUYEN

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	183500000X	Pharmacist	20115	NV

General Provider Information

NPI Number	:	1033723853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA NGUYEN

Provider Business Mailing Address
First Line	:	3808 E TROPICANA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-6021
Country	:	US
Telephone Number	:	702-547-0830
Fax Number	:	702-547-4003

Provider Business Practice Location Address
First Line	:	3808 E TROPICANA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-6021
Country	:	US
Telephone Number	:	702-547-0830
Fax Number	:	702-547-4003

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

Provider Enumeration Date	:	08/31/2020
Last Update Date	:	08/31/2020

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Directions to “ LISA NGUYEN ” Practice Location

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