MEDICARE: DR. THANH DAI NGUYEN PHARMD

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	RPH53526	CA

General Provider Information

NPI Number	:	1730460817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THANH DAI NGUYEN PHARMD

Provider Business Mailing Address
First Line	:	1050 GILMAN ST
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94710-1532
Country	:	US
Telephone Number	:	510-528-8274
Fax Number	:	510-528-8659

Provider Business Practice Location Address
First Line	:	1050 GILMAN ST
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94710-1532
Country	:	US
Telephone Number	:	510-528-8274
Fax Number	:	510-528-8659

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

Provider Enumeration Date	:	09/02/2011
Last Update Date	:	09/02/2011

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