Provider Demographics
NPI:1154912830
Name:NGUYEN, DAT QUOC (PHARMD)
Entity type:Individual
Prefix:
First Name:DAT
Middle Name:QUOC
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 1:763 VASHON PL NE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-4714
Mailing Address - Country:US
Mailing Address - Phone:206-852-6576
Mailing Address - Fax:
Practice Address - Street 1:222 PIKE ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2108
Practice Address - Country:US
Practice Address - Phone:206-903-8392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH61062177183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist