MEDICARE: DR. ANH DEREK NGUYEN PHARM, D.

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	54065	CA

General Provider Information

NPI Number	:	1992073613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANH DEREK NGUYEN PHARM, D.

Provider Business Mailing Address
First Line	:	7878 CRESCENT AVE
Second Line	:
City	:	BUENA PARK
State	:	CA
Zip	:	90620-3950
Country	:	US
Telephone Number	:	714-226-0238
Fax Number	:	714-226-0921

Provider Business Practice Location Address
First Line	:	7878 CRESCENT AVE
Second Line	:
City	:	BUENA PARK
State	:	CA
Zip	:	90620-3950
Country	:	US
Telephone Number	:	714-226-0238
Fax Number	:	714-226-0921

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

Provider Enumeration Date	:	12/08/2011
Last Update Date	:	12/08/2011

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