MEDICARE: TAN 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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	67960	TX

General Provider Information

NPI Number	:	1710583638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAN NGUYEN PHARM D

Provider Business Mailing Address
First Line	:	9125 W SAM HOUSTON PKWY N
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77064-6339
Country	:	US
Telephone Number	:	281-477-0585
Fax Number	:

Provider Business Practice Location Address
First Line	:	9125 W SAM HOUSTON PKWY N
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77064-6339
Country	:	US
Telephone Number	:	281-477-0585
Fax Number	:

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

Provider Enumeration Date	:	12/07/2020
Last Update Date	:	12/07/2020

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