Provider Demographics
NPI:1194094797
Name:NGUYEN, TUNG THANH (PHARM D)
Entity type:Individual
Prefix:MR
First Name:TUNG
Middle Name:THANH
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 1:2868 RICE CREEK PKWY NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-6778
Mailing Address - Country:US
Mailing Address - Phone:763-218-9262
Mailing Address - Fax:
Practice Address - Street 1:1700 RICE ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55113-6812
Practice Address - Country:US
Practice Address - Phone:651-251-9811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118184183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist