MEDICARE: KAREN NGOC-KHANH 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	PS32862	FL
2	183500000X	Pharmacist	14688	MD
3	183500000X	Pharmacist	50618	CA
4	183500000X	Pharmacist	0202012644	VA

General Provider Information

NPI Number	:	1538769138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN NGOC-KHANH NGUYEN

Provider Business Mailing Address
First Line	:	3450 WASHINGTON BLVD
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22201-4508
Country	:	US
Telephone Number	:	703-351-9220
Fax Number	:

Provider Business Practice Location Address
First Line	:	3450 WASHINGTON BLVD
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22201-4508
Country	:	US
Telephone Number	:	703-351-9220
Fax Number	:

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

Provider Enumeration Date	:	11/01/2020
Last Update Date	:	11/01/2020

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