Provider Demographics
NPI:1588946446
Name:NGUYEN, THANH PHUOC (PHARMD)
Entity type:Individual
Prefix:DR
First Name:THANH
Middle Name:PHUOC
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 N RENGSTORFF AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-4222
Mailing Address - Country:US
Mailing Address - Phone:650-969-5784
Mailing Address - Fax:650-969-1467
Practice Address - Street 1:112 N RENGSTORFF AVE
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94043-4222
Practice Address - Country:US
Practice Address - Phone:650-969-5784
Practice Address - Fax:650-969-1467
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH55243183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist