Provider Demographics
NPI:1285263871
Name:NGUYEN, DOMINIQUE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DOMINIQUE
Middle Name:
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 1:5210 FALLEN LEAF DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-4740
Mailing Address - Country:US
Mailing Address - Phone:954-328-4762
Mailing Address - Fax:
Practice Address - Street 1:6308 BENJAMIN RD STE 709
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-5174
Practice Address - Country:US
Practice Address - Phone:727-896-0001
Practice Address - Fax:727-896-0002
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-06
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS540633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS54063OtherDEPARTMENT OF HEALTH