MEDICARE: LISA NGUYEN RPH.

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	39762	TX

General Provider Information

NPI Number	:	1336148501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA NGUYEN RPH.

Provider Business Mailing Address
First Line	:	10514 DUDE RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77064-7133
Country	:	US
Telephone Number	:	832-237-3128
Fax Number	:

Provider Business Practice Location Address
First Line	:	10514 DUDE RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77064-7133
Country	:	US
Telephone Number	:	832-237-3128
Fax Number	:

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	07/08/2007

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