Provider Demographics
NPI:1194506402
Name:NGUYEN, PHUC VU (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:PHUC
Middle Name:VU
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CHAUNCY ST APT 32
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-2613
Mailing Address - Country:US
Mailing Address - Phone:781-521-8168
Mailing Address - Fax:
Practice Address - Street 1:999 WATERTOWN ST
Practice Address - Street 2:
Practice Address - City:WEST NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02465-2130
Practice Address - Country:US
Practice Address - Phone:617-964-7736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2024-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH997005183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist