Provider Demographics
NPI:1487839387
Name:NGUYEN, THUYTRANG (PHARMACIST)
Entity type:Individual
Prefix:
First Name:THUYTRANG
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5810 187TH ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-2229
Mailing Address - Country:US
Mailing Address - Phone:718-357-8945
Mailing Address - Fax:718-357-8945
Practice Address - Street 1:4502 43RD AVE
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-1902
Practice Address - Country:US
Practice Address - Phone:718-433-0940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050942183500000X
NJ28RI02984100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01618455Medicaid