Provider Demographics
NPI:1366629289
Name:HA-LIEU NANCY NGUYEN
Entity type:Organization
Organization Name:HA-LIEU NANCY NGUYEN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST (OWNER)
Authorized Official - Prefix:
Authorized Official - First Name:HA-LIEU
Authorized Official - Middle Name:NANCY
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:916-393-1071
Mailing Address - Street 1:6665 STOCKTON BLVD
Mailing Address - Street 2:#6
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-1634
Mailing Address - Country:US
Mailing Address - Phone:916-393-1071
Mailing Address - Fax:916-393-1072
Practice Address - Street 1:6665 STOCKTON BLVD
Practice Address - Street 2:#6
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-1634
Practice Address - Country:US
Practice Address - Phone:916-393-1071
Practice Address - Fax:916-393-1072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHA4425003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA442500Medicaid
CA4682830001Medicare NSC