MEDICARE: PHAT H NGUYEN

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	RP457791	PA

General Provider Information

NPI Number	:	1265216535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHAT H NGUYEN

Provider Business Mailing Address
First Line	:	2051 S BEECHWOOD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-2705
Country	:	US
Telephone Number	:	267-401-2633
Fax Number	:

Provider Business Practice Location Address
First Line	:	2051 S BEECHWOOD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-2705
Country	:	US
Telephone Number	:	267-401-2633
Fax Number	:

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

Provider Enumeration Date	:	08/18/2023
Last Update Date	:	08/18/2023

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Directions to “ PHAT H NGUYEN ” Practice Location

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