MEDICARE: DR. CANH-NHUT M 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	1835P1200X	Pharmacotherapy Pharmacist	53175	CA

General Provider Information

NPI Number	:	1457380966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CANH-NHUT M NGUYEN PHARM.D.

Provider Business Mailing Address
First Line	:	4154 COSTERO RISCO
Second Line	:
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92673-6408
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3350 LA JOLLA VILLAGE DR
Second Line	:	PHARMACY SERVICE: 119
City	:	LA JOLLA
State	:	CA
Zip	:	92037-1806
Country	:	US
Telephone Number	:	858-642-1616
Fax Number	:

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

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	07/08/2007

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