MEDICARE: BUU-AN NGOC 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	11943	AZ

General Provider Information

NPI Number	:	1942206404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BUU-AN NGOC NGUYEN PHARMD

Provider Business Mailing Address
First Line	:	91-929 PUAMAEOLE ST
Second Line	:	UNIT 5D
City	:	EWA BEACH
State	:	HI
Zip	:	96706-2112
Country	:	US
Telephone Number	:	808-433-0767
Fax Number	:	808-433-0737

Provider Business Practice Location Address
First Line	:	459 PATTERSON ROAD
Second Line	:	PHARMACY SERVICE
City	:	HONOLULU
State	:	HI
Zip	:	96819
Country	:	US
Telephone Number	:	808-433-0767
Fax Number	:

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	07/08/2007

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