MEDICARE: DR. DIANA THAO 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	PI163116	MA

General Provider Information

NPI Number	:	1265260681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANA THAO NGUYEN PHARMD

Provider Business Mailing Address
First Line	:	317 WALNUT ST
Second Line	:
City	:	NEWTONVILLE
State	:	MA
Zip	:	02460-1927
Country	:	US
Telephone Number	:	857-294-4455
Fax Number	:	857-297-4458

Provider Business Practice Location Address
First Line	:	317 WALNUT ST
Second Line	:
City	:	NEWTONVILLE
State	:	MA
Zip	:	02460-1927
Country	:	US
Telephone Number	:	857-294-4455
Fax Number	:	857-297-4458

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

Provider Enumeration Date	:	07/25/2024
Last Update Date	:	07/25/2024

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