MEDICARE: BRENDON 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	59939	CA

General Provider Information

NPI Number	:	1528598869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDON NGUYEN PHARM.D.

Provider Business Mailing Address
First Line	:	2491 PACIFIC AVE STE 1
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-2900
Country	:	US
Telephone Number	:	562-595-9333
Fax Number	:	562-595-4111

Provider Business Practice Location Address
First Line	:	2491 PACIFIC AVE STE 1
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-2900
Country	:	US
Telephone Number	:	562-595-9333
Fax Number	:	562-595-9333

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

Provider Enumeration Date	:	06/19/2017
Last Update Date	:	06/19/2017

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