Provider Demographics
NPI:1386966190
Name:NGUYEN, THAO P
Entity type:Individual
Prefix:MRS
First Name:THAO
Middle Name:P
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 1:5051 E BONANZA RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-3514
Mailing Address - Country:US
Mailing Address - Phone:702-459-1003
Mailing Address - Fax:702-438-3053
Practice Address - Street 1:5051 E BONANZA RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-3514
Practice Address - Country:US
Practice Address - Phone:702-459-1003
Practice Address - Fax:702-438-3053
Is Sole Proprietor?:No
Enumeration Date:2010-02-20
Last Update Date:2010-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15972183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist