MEDICARE: TAVIN 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	PD16274	AR

General Provider Information

NPI Number	:	1790404978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAVIN NGUYEN PHARMD

Provider Business Mailing Address
First Line	:	3632 JOHNSON MILL BLVD APT 305
Second Line	:
City	:	SPRINGDALE
State	:	AR
Zip	:	72762-6373
Country	:	US
Telephone Number	:	479-739-7227
Fax Number	:

Provider Business Practice Location Address
First Line	:	8600 HIGHWAY 71 S
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72908-8042
Country	:	US
Telephone Number	:	479-289-6898
Fax Number	:

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

Provider Enumeration Date	:	08/23/2022
Last Update Date	:	08/23/2022

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