Provider Demographics
NPI:1104433812
Name:NGUYEN, NICK NHUT (PHARMD)
Entity type:Individual
Prefix:
First Name:NICK
Middle Name:NHUT
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10691 BALLAST AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-5308
Mailing Address - Country:US
Mailing Address - Phone:714-333-8271
Mailing Address - Fax:
Practice Address - Street 1:701 RIO RANCHO RD
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-7018
Practice Address - Country:US
Practice Address - Phone:909-634-3152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-26
Last Update Date:2020-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83431183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist