Provider Demographics
NPI:1306168679
Name:NGUYEN, YEN HOANG (PHARMD)
Entity type:Individual
Prefix:
First Name:YEN
Middle Name:HOANG
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 1:1877 TRADEWINDS DR SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508-5337
Mailing Address - Country:US
Mailing Address - Phone:616-455-2584
Mailing Address - Fax:
Practice Address - Street 1:701 68TH ST SW
Practice Address - Street 2:
Practice Address - City:BYRON CENTER
Practice Address - State:MI
Practice Address - Zip Code:49315-8372
Practice Address - Country:US
Practice Address - Phone:616-281-8212
Practice Address - Fax:616-281-0523
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302035878183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist