MEDICARE: HOA THAI NGUYEN PHARMACIST

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	RPH61825	CA

General Provider Information

NPI Number	:	1265751895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOA THAI NGUYEN PHARMACIST

Provider Business Mailing Address
First Line	:	32856 NORTHSHIRE CIR
Second Line	:
City	:	TEMECULA
State	:	CA
Zip	:	92592-7211
Country	:	US
Telephone Number	:	951-302-5687
Fax Number	:	950-302-5687

Provider Business Practice Location Address
First Line	:	40481 MURRIETA HOT SPRINGS RD
Second Line	:
City	:	MURRIETA
State	:	CA
Zip	:	92563-6401
Country	:	US
Telephone Number	:	951-698-9793
Fax Number	:	951-698-3362

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

Provider Enumeration Date	:	05/21/2010
Last Update Date	:	05/21/2010

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