Provider Demographics
NPI:1063405140
Name:NGUYEN, HA-LIEU NANCY
Entity type:Individual
Prefix:
First Name:HA-LIEU
Middle Name:NANCY
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6665 STOCKTON BLVD
Mailing Address - Street 2:SUITE # 6
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-1634
Mailing Address - Country:US
Mailing Address - Phone:916-393-1071
Mailing Address - Fax:916-393-1072
Practice Address - Street 1:6665 STOCKTON BLVD
Practice Address - Street 2:SUITE # 6
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-1634
Practice Address - Country:US
Practice Address - Phone:916-393-1071
Practice Address - Fax:916-393-1072
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44661183500000X
CAPHA4425003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA442500Medicaid