MEDICARE: DR. KHOI THANH 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	183500000X	Pharmacist	PS47959	FL

General Provider Information

NPI Number	:	1154690881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KHOI THANH NGUYEN PHARM.D.

Provider Business Mailing Address
First Line	:	24 W ORANGE ST
Second Line	:
City	:	APOPKA
State	:	FL
Zip	:	32703-4210
Country	:	US
Telephone Number	:	407-257-7004
Fax Number	:

Provider Business Practice Location Address
First Line	:	7003 PRESIDENTS DR STE 250
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32809-5533
Country	:	US
Telephone Number	:	407-859-6197
Fax Number	:

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

Provider Enumeration Date	:	12/27/2011
Last Update Date	:	12/27/2011

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