Provider Demographics
NPI:1427815083
Name:NGUYEN, THOI DAC
Entity type:Individual
Prefix:MR
First Name:THOI
Middle Name:DAC
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4452
Mailing Address - Country:US
Mailing Address - Phone:212-693-6688
Mailing Address - Fax:212-693-6677
Practice Address - Street 1:87 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4452
Practice Address - Country:US
Practice Address - Phone:212-693-6688
Practice Address - Fax:212-693-6677
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035376333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy