MEDICARE: MRS. TIFFANY BAO 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	42807	TX

General Provider Information

NPI Number	:	1255608063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TIFFANY BAO NGUYEN PHARMD

Provider Business Mailing Address
First Line	:	4414 BRIDGESTONE LAKES DR
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77388-3154
Country	:	US
Telephone Number	:	281-288-6458
Fax Number	:

Provider Business Practice Location Address
First Line	:	6926 ANTOINE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77091-1212
Country	:	US
Telephone Number	:	713-957-8185
Fax Number	:

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

Provider Enumeration Date	:	11/22/2011
Last Update Date	:	11/22/2011

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