Provider Demographics
NPI:1598571655
Name:NGUYEN, BRIAN (RPH)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9040 WADSWORTH BLVD APT 321
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-4953
Mailing Address - Country:US
Mailing Address - Phone:909-289-6011
Mailing Address - Fax:
Practice Address - Street 1:4705 WEITZEL ST
Practice Address - Street 2:
Practice Address - City:TIMNATH
Practice Address - State:CO
Practice Address - Zip Code:80547-4703
Practice Address - Country:US
Practice Address - Phone:970-416-6125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0025047183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist