Provider Demographics
NPI:1306116884
Name:NGUYEN, KATHY (PHARMD)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13503 SE MILL PLAIN BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-6984
Mailing Address - Country:US
Mailing Address - Phone:360-256-9875
Mailing Address - Fax:
Practice Address - Street 1:13503 SE MILL PLAIN BLVD STE 120
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-1804
Practice Address - Country:US
Practice Address - Phone:360-256-9875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-30
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 60213522183500000X
ORRPH-0012851183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist