MEDICARE: STEVEN TIEN 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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	18299	NV

General Provider Information

NPI Number	:	1689205031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN TIEN NGUYEN

Provider Business Mailing Address
First Line	:	9750 S MARYLAND PKWY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-7119
Country	:	US
Telephone Number	:	702-617-1074
Fax Number	:	702-617-1077

Provider Business Practice Location Address
First Line	:	9750 S MARYLAND PKWY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-7119
Country	:	US
Telephone Number	:	702-617-1074
Fax Number	:

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

Provider Enumeration Date	:	02/03/2020
Last Update Date	:	02/03/2020

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