MEDICARE: KIM 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	PS48654	FL

General Provider Information

NPI Number	:	1912503012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM NGUYEN

Provider Business Mailing Address
First Line	:	8602 HUNTFIELD ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33635-1514
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13839 LITTLE RD
Second Line	:
City	:	HUDSON
State	:	FL
Zip	:	34667-8026
Country	:	US
Telephone Number	:	727-868-9420
Fax Number	:

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

Provider Enumeration Date	:	12/05/2020
Last Update Date	:	12/05/2020

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Directions to “ KIM NGUYEN ” Practice Location

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