MEDICARE: MINH LUAN Q 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	022258	LA

General Provider Information

NPI Number	:	1659888485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINH LUAN Q NGUYEN

Provider Business Mailing Address
First Line	:	412 CHERRYWOOD DR
Second Line	:
City	:	GRETNA
State	:	LA
Zip	:	70056-7711
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	412 CHERRYWOOD DR
Second Line	:
City	:	GRETNA
State	:	LA
Zip	:	70056-7711
Country	:	US
Telephone Number	:	504-331-8443
Fax Number	:

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

Provider Enumeration Date	:	01/02/2018
Last Update Date	:	01/02/2018

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Directions to “ MINH LUAN Q NGUYEN ” Practice Location

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