MEDICARE: PRISCILLA PHUC TRAM 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	0012813	OR

General Provider Information

NPI Number	:	1316222367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRISCILLA PHUC TRAM NGUYEN PHARMD

Provider Business Mailing Address
First Line	:	7325 SE 133RD PLACE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97236
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 SE DWYER DR STE 304
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97222-6548
Country	:	US
Telephone Number	:	503-513-8343
Fax Number	:	503-513-8069

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

Provider Enumeration Date	:	10/20/2011
Last Update Date	:	05/22/2013

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