MEDICARE: THU NGUYEN PHARMD

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	57564	TX

General Provider Information

NPI Number	:	1134968951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THU NGUYEN PHARMD

Provider Business Mailing Address
First Line	:	7464 PRAIRIESIDE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-2146
Country	:	US
Telephone Number	:	504-352-4180
Fax Number	:

Provider Business Practice Location Address
First Line	:	7464 PRAIRIESIDE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-2146
Country	:	US
Telephone Number	:	504-352-4180
Fax Number	:

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

Provider Enumeration Date	:	05/21/2024
Last Update Date	:	05/21/2024

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Directions to “ THU NGUYEN PHARMD” Practice Location

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