MEDICARE: DR. DIEP H NGUYEN PHARMACIST

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	83464	CA

General Provider Information

NPI Number	:	1457955619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIEP H NGUYEN PHARMACIST

Provider Business Mailing Address
First Line	:	2321 HAWTHORNE BLVD
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90278-3400
Country	:	US
Telephone Number	:	310-214-4891
Fax Number	:	310-214-4943

Provider Business Practice Location Address
First Line	:	3331 W CENTURY BLVD
Second Line	:
City	:	INGLEWOOD
State	:	CA
Zip	:	90303-1366
Country	:	US
Telephone Number	:	310-671-1523
Fax Number	:

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

Provider Enumeration Date	:	11/27/2020
Last Update Date	:	11/21/2022

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