MEDICARE: DAVE D 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	PS22197	FL

General Provider Information

NPI Number	:	1407174170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVE D NGUYEN RPH

Provider Business Mailing Address
First Line	:	11812 LIPSEY RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-3622
Country	:	US
Telephone Number	:	813-842-6453
Fax Number	:

Provider Business Practice Location Address
First Line	:	4311 W WATERS AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-1901
Country	:	US
Telephone Number	:	813-249-6593
Fax Number	:

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

Provider Enumeration Date	:	05/05/2010
Last Update Date	:	05/05/2010

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