Provider Demographics
NPI:1285399782
Name:NGUYEN, ANHMAI
Entity type:Individual
Prefix:
First Name:ANHMAI
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6051 UNIVERSITY TOWN CENTRE DRIVE
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26501
Mailing Address - Country:US
Mailing Address - Phone:304-598-3404
Mailing Address - Fax:
Practice Address - Street 1:6051 UNIVERSITY TOWN CENTRE DRIVE
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:WV
Practice Address - Zip Code:26501
Practice Address - Country:US
Practice Address - Phone:304-598-3404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0007598183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist