MEDICARE: TAM MINH 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	183500000X	Pharmacist	55442	CA
2	183500000X	Pharmacist	41907	TX

General Provider Information

NPI Number	:	1518241314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAM MINH NGUYEN PHARM.D.

Provider Business Mailing Address
First Line	:	1219 N CEDAR AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93703-4313
Country	:	US
Telephone Number	:	559-498-8283
Fax Number	:	559-498-0252

Provider Business Practice Location Address
First Line	:	1219 N CEDAR AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93703-4313
Country	:	US
Telephone Number	:	559-498-8283
Fax Number	:	559-498-0252

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

Provider Enumeration Date	:	09/28/2011
Last Update Date	:	09/28/2011

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