Provider Demographics
NPI:1104270867
Name:NGUYEN, ANDREW CHI TRUNG (PHARM D)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:CHI TRUNG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 AMES CROSSING RD STE 200
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-2498
Mailing Address - Country:US
Mailing Address - Phone:800-858-0723
Mailing Address - Fax:
Practice Address - Street 1:2900 AMES CROSSING RD STE 200
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-2498
Practice Address - Country:US
Practice Address - Phone:800-858-0723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75220183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA75220OtherCALIFORNIA BOARD OF PHARMACY PHARMACIST LICENSE
CA31156OtherCALIFORNIA BOARD OF PHARMACY INTERN LISCENSE