MEDICARE: XUAN- THAO 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	RP040230L	PA

General Provider Information

NPI Number	:	1740557446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	XUAN- THAO NGUYEN

Provider Business Mailing Address
First Line	:	272 LAMPLIGHTER LN
Second Line	:
City	:	HUNTINGDON VALLEY
State	:	PA
Zip	:	19006-3033
Country	:	US
Telephone Number	:	215-510-3861
Fax Number	:

Provider Business Practice Location Address
First Line	:	1528 N BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19121-4311
Country	:	US
Telephone Number	:	215-765-9332
Fax Number	:

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

Provider Enumeration Date	:	11/23/2011
Last Update Date	:	11/23/2011

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Directions to “ XUAN- THAO NGUYEN ” Practice Location

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