MEDICARE: SUSANNA 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	207N00000X	Dermatology Physician	48919	TX

General Provider Information

NPI Number	:	1083458129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSANNA NGUYEN PHARM.D

Provider Business Mailing Address
First Line	:	914 SNOVER ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-5629
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	819 PEAKWOOD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-2905
Country	:	US
Telephone Number	:	281-645-5013
Fax Number	:

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

Provider Enumeration Date	:	06/24/2024
Last Update Date	:	06/24/2024

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