MEDICARE: DR. JOHN NGUYEN PHARM.D.

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	50960	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50960	OTHER	CA	CALIFORNIA BOARD OF PHARMACY

General Provider Information

NPI Number	:	1346224789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN NGUYEN PHARM.D.

Provider Business Mailing Address
First Line	:	1906 VISTA DEL LAGO DR.
Second Line	:	SUITE G
City	:	VALLEY SPRINGS
State	:	CA
Zip	:	95252
Country	:	US
Telephone Number	:	209-920-3299
Fax Number	:	209-920-3391

Provider Business Practice Location Address
First Line	:	1906 VISTA DEL LAGO DR.
Second Line	:	SUITE G
City	:	VALLEY SPRINGS
State	:	CA
Zip	:	95252
Country	:	US
Telephone Number	:	209-920-3299
Fax Number	:	209-920-3391

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

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	09/07/2012

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