MEDICARE: ANH 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	66117	CA

General Provider Information

NPI Number	:	1548530975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANH NGUYEN PHARM D

Provider Business Mailing Address
First Line	:	1181 N STATE ST
Second Line	:
City	:	SAN JACINTO
State	:	CA
Zip	:	92583-6317
Country	:	US
Telephone Number	:	951-487-3810
Fax Number	:	951-654-6283

Provider Business Practice Location Address
First Line	:	1181 N STATE ST
Second Line	:
City	:	SAN JACINTO
State	:	CA
Zip	:	92583-6317
Country	:	US
Telephone Number	:	951-487-3810
Fax Number	:	951-654-6283

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

Provider Enumeration Date	:	01/02/2012
Last Update Date	:	01/02/2012

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