MEDICARE: MS. EMILY QUYNH NGUYEN RPH

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	1835G0303X	Geriatric Pharmacist	17599	NV
2	1835P1200X	Pharmacotherapy Pharmacist	17599	NV
3	1835P1300X	Psychiatric Pharmacist	17599	NV

General Provider Information

NPI Number	:	1215210620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EMILY QUYNH NGUYEN RPH

Provider Business Mailing Address
First Line	:	6101 W LAKE MEAD BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-2660
Country	:	US
Telephone Number	:	702-648-2732
Fax Number	:

Provider Business Practice Location Address
First Line	:	6101 W LAKE MEAD BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-2660
Country	:	US
Telephone Number	:	702-648-2732
Fax Number	:

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

Provider Enumeration Date	:	09/21/2011
Last Update Date	:	09/21/2011

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