Provider Demographics
NPI:1194133793
Name:NGUYEN, ANH (RPH)
Entity type:Individual
Prefix:
First Name:ANH
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3612 EVERGLADE AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-2032
Mailing Address - Country:US
Mailing Address - Phone:559-298-7371
Mailing Address - Fax:559-862-2065
Practice Address - Street 1:6855 N WILLOW AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5949
Practice Address - Country:US
Practice Address - Phone:559-298-7371
Practice Address - Fax:559-862-2065
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-27
Last Update Date:2014-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55264183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist