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NPI Code Detail

MEDICARE: MRS. MARY L NGUYEN I PHARMD

MEDICARE: MRS. MARY L NGUYEN I 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
1183500000XPharmacist41047TX

General Provider Information

NPI Number : 1730476508
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARY L NGUYEN I PHARMD
Provider Business Mailing Address
First Line : 751 ALTA MERE DR
Second Line : T-2425
City : FORT WORTH
State : TX
Zip : 76116-1526
Country : US
Telephone Number : 817-566-0566
Fax Number : 817-566-0576
Provider Business Practice Location Address
First Line : 751 ALTA MERE DR
Second Line : T-2425
City : FORT WORTH
State : TX
Zip : 76116-1526
Country : US
Telephone Number : 817-566-0566
Fax Number : 817-566-0576
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2011
Last Update Date : 06/30/2011

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