MEDICARE: THANG DUC 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	47835	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386249597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THANG DUC NGUYEN PHARMD

Provider Business Mailing Address
First Line	:	5012 TRAIL LAKE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-2028
Country	:	US
Telephone Number	:	817-292-1700
Fax Number	:	817-292-8246

Provider Business Practice Location Address
First Line	:	5012 TRAIL LAKE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-2028
Country	:	US
Telephone Number	:	817-292-1700
Fax Number	:	817-292-8246

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

Provider Enumeration Date	:	12/03/2020
Last Update Date	:	12/03/2020

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