MEDICARE: THO 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	27154	NC

General Provider Information

NPI Number	:	1447748512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THO NGUYEN

Provider Business Mailing Address
First Line	:	10336 HUGUE WAY
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28214-8855
Country	:	US
Telephone Number	:	432-553-0051
Fax Number	:

Provider Business Practice Location Address
First Line	:	2903 CENTRAL AVE STE A
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-6073
Country	:	US
Telephone Number	:	432-553-0051
Fax Number	:

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

Provider Enumeration Date	:	04/24/2018
Last Update Date	:	04/24/2018

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Directions to “ THO NGUYEN ” Practice Location

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