MEDICARE: ANGEL XUAN-NGUYEN BUI

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	183700000X	Pharmacy Technician	297859	TX

General Provider Information

NPI Number	:	1053167346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGEL XUAN-NGUYEN BUI

Provider Business Mailing Address
First Line	:	3451 HERITAGE TRACE PKWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-7505
Country	:	US
Telephone Number	:	817-232-8632
Fax Number	:	682-708-1783

Provider Business Practice Location Address
First Line	:	3451 HERITAGE TRACE PKWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-7505
Country	:	US
Telephone Number	:	817-232-8632
Fax Number	:	682-708-1783

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

Provider Enumeration Date	:	04/26/2024
Last Update Date	:	04/26/2024

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