MEDICARE: LUU PHUONG 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	58306	CA

General Provider Information

NPI Number	:	1659744852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUU PHUONG NGUYEN PHARM. D.

Provider Business Mailing Address
First Line	:	2559 S KING RD
Second Line	:	STE B10
City	:	SAN JOSE
State	:	CA
Zip	:	95122-1894
Country	:	US
Telephone Number	:	408-440-2077
Fax Number	:	866-373-0415

Provider Business Practice Location Address
First Line	:	2559 S KING RD STE B10
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95122-1894
Country	:	US
Telephone Number	:	408-440-2077
Fax Number	:	866-373-0415

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

Provider Enumeration Date	:	11/10/2015
Last Update Date	:	07/20/2016

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