MEDICARE: NGUYEN T 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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	RPH026105	GA

General Provider Information

NPI Number	:	1255962080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NGUYEN T NGUYEN PHARMD

Provider Business Mailing Address
First Line	:	302 WOODBINE RD
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31410-1017
Country	:	US
Telephone Number	:	912-224-3844
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 E VICTORY DR
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31404-3713
Country	:	US
Telephone Number	:	912-236-0750
Fax Number	:	912-495-0698

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

Provider Enumeration Date	:	01/30/2020
Last Update Date	:	01/30/2020

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