MEDICARE: DUNG 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	019472	LA

General Provider Information

NPI Number	:	1053663849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUNG NGUYEN

Provider Business Mailing Address
First Line	:	26852 HIGHWAY 23
Second Line	:
City	:	PORT SULPHUR
State	:	LA
Zip	:	70083-2508
Country	:	US
Telephone Number	:	504-715-2197
Fax Number	:

Provider Business Practice Location Address
First Line	:	26852 HIGHWAY 23
Second Line	:
City	:	PORT SULPHUR
State	:	LA
Zip	:	70083-2508
Country	:	US
Telephone Number	:	504-715-2197
Fax Number	:

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

Provider Enumeration Date	:	10/04/2012
Last Update Date	:	10/04/2012

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Directions to “ DUNG NGUYEN ” Practice Location

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