MEDICARE: THU 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	16797-40	WI

General Provider Information

NPI Number	:	1336530351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THU NGUYEN

Provider Business Mailing Address
First Line	:	15170 W GREENFIELD AVE
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53005-7018
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15170 W GREENFIELD AVE
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53005-7018
Country	:	US
Telephone Number	:	262-782-2787
Fax Number	:

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

Provider Enumeration Date	:	02/12/2015
Last Update Date	:	02/12/2015

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Directions to “ THU NGUYEN ” Practice Location

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