MEDICARE: DERMPRENEUR, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	183500000X	Pharmacist
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
3	207ND0101X	MOHS-Micrographic Surgery Physician
4	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1821786583
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DERMPRENEUR, PLLC

Provider Business Mailing Address
First Line	:	819 PEAKWOOD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-2905
Country	:	US
Telephone Number	:	281-645-5013
Fax Number	:	713-903-7958

Provider Business Practice Location Address
First Line	:	819 PEAKWOOD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-2905
Country	:	US
Telephone Number	:	281-645-5013
Fax Number	:	713-903-7958

Authorized Official
Title or Position	:	PHYSICIAN DERMATOLOGIST
Name	:	DR. DANIEL ANH-KHOA NGUYEN
Credential	:	DO, PHARMD
Telephone Number	:	281-645-5013

Provider Enumeration Date	:	04/28/2023
Last Update Date	:	09/10/2023

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