Provider Demographics
NPI:1417557554
Name:VAN, MINH PHUONG NGUYEN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MINH PHUONG
Middle Name:NGUYEN
Last Name:VAN
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 1:407 W GIBSON ST APT 54
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TX
Mailing Address - Zip Code:75951-4965
Mailing Address - Country:US
Mailing Address - Phone:346-314-1560
Mailing Address - Fax:
Practice Address - Street 1:800 W GIBSON ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-4914
Practice Address - Country:US
Practice Address - Phone:409-384-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67450183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist