Provider Demographics
NPI:1316239536
Name:NGUYEN, THAO P (PHARMD)
Entity type:Individual
Prefix:
First Name:THAO
Middle Name:P
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 1:2309 MONDAVI CT
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-2352
Mailing Address - Country:US
Mailing Address - Phone:704-841-4019
Mailing Address - Fax:
Practice Address - Street 1:11516 PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-2691
Practice Address - Country:US
Practice Address - Phone:704-841-4019
Practice Address - Fax:704-841-8124
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16613183500000X
SC11941183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0609616Medicaid
NC0609616Medicaid