Provider Demographics
NPI:1558116376
Name:NGUYEN, JULIE DIEM (RPH)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:DIEM
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 W KNOX AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-5542
Mailing Address - Country:US
Mailing Address - Phone:714-364-1400
Mailing Address - Fax:714-364-1448
Practice Address - Street 1:3020 SATURN ST STE 100
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-6262
Practice Address - Country:US
Practice Address - Phone:714-364-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53314183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist