Provider Demographics
NPI:1063919546
Name:NGUYEN, TAN THANH (RPH)
Entity type:Individual
Prefix:
First Name:TAN
Middle Name:THANH
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 FIG TREE LN APT 7B
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-6515
Mailing Address - Country:US
Mailing Address - Phone:510-283-3792
Mailing Address - Fax:
Practice Address - Street 1:580 BAILEY RD BAY POINT
Practice Address - Street 2:
Practice Address - City:BAY POINT
Practice Address - State:CA
Practice Address - Zip Code:94565-4304
Practice Address - Country:US
Practice Address - Phone:510-283-3792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78388183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist