MEDICARE: TUNG THANH NGUYEN R . PH

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	13546	CO

General Provider Information

NPI Number	:	1043653165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TUNG THANH NGUYEN R . PH

Provider Business Mailing Address
First Line	:	15109 E COLFAX AVE
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80011-5729
Country	:	US
Telephone Number	:	303-343-3170
Fax Number	:	303-365-0961

Provider Business Practice Location Address
First Line	:	15109 E COLFAX AVE
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80011-5729
Country	:	US
Telephone Number	:	303-343-3170
Fax Number	:	303-365-0961

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

Provider Enumeration Date	:	04/08/2013
Last Update Date	:	04/08/2013

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