Provider Demographics
NPI:1588112684
Name:NGUYEN, TRAM (PHARMD)
Entity type:Individual
Prefix:
First Name:TRAM
Middle Name:
Last Name:NGUYEN
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 1:8200 CRESTWOOD HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-3118
Mailing Address - Country:US
Mailing Address - Phone:703-448-0679
Mailing Address - Fax:
Practice Address - Street 1:8200 CRESTWOOD HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-3118
Practice Address - Country:US
Practice Address - Phone:703-448-0679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-17
Last Update Date:2016-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202210772183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist