MEDICARE: MRS. BACHYEN THI 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	RPH 43103	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PHA394370	OTHER	CA	MEDICAL PROVIDER

General Provider Information

NPI Number	:	1639178221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BACHYEN THI NGUYEN PHARMACIST

Provider Business Mailing Address
First Line	:	2887 SENTER RD
Second Line	:	#101
City	:	SAN JOSE
State	:	CA
Zip	:	95111-1180
Country	:	US
Telephone Number	:	408-629-0106
Fax Number	:	408-629-1234

Provider Business Practice Location Address
First Line	:	2887 SENTER RD
Second Line	:	#101
City	:	SAN JOSE
State	:	CA
Zip	:	95111-1180
Country	:	US
Telephone Number	:	408-629-0106
Fax Number	:	408-629-1234

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	07/08/2007

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