MEDICARE: PHUONG THAO THI 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	37311	TX
2	183500000X	Pharmacist	12509	OK

General Provider Information

NPI Number	:	1265642656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHUONG THAO THI NGUYEN

Provider Business Mailing Address
First Line	:	3503 UNIVERSITY PARK LN
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75062-6590
Country	:	US
Telephone Number	:	972-650-0979
Fax Number	:	214-630-0473

Provider Business Practice Location Address
First Line	:	4828 READING ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75247-6705
Country	:	US
Telephone Number	:	214-630-0333
Fax Number	:	214-630-0473

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/08/2007

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Directions to “ PHUONG THAO THI NGUYEN ” Practice Location

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