Provider Demographics
NPI:1154923712
Name:NGUYEN, HENRY CHRISTIAN
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:CHRISTIAN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14320 HIGHWAY 15 S
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39339-6439
Mailing Address - Country:US
Mailing Address - Phone:662-773-9033
Mailing Address - Fax:
Practice Address - Street 1:14320 HIGHWAY 15 S
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:MS
Practice Address - Zip Code:39339-6439
Practice Address - Country:US
Practice Address - Phone:662-773-9033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-16795183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist