MEDICARE: MR. DUNG ANH NGUYEN PHARMACY MANAGER

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	15133	CO

General Provider Information

NPI Number	:	1306189501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DUNG ANH NGUYEN PHARMACY MANAGER

Provider Business Mailing Address
First Line	:	1927 S WADSWORTH BLVD
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80227-3271
Country	:	US
Telephone Number	:	303-985-8797
Fax Number	:	303-989-6410

Provider Business Practice Location Address
First Line	:	1927 S WADSWORTH BLVD
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80227-3271
Country	:	US
Telephone Number	:	303-985-8797
Fax Number	:	303-989-6410

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

Provider Enumeration Date	:	04/05/2013
Last Update Date	:	04/05/2013

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