Provider Demographics
NPI:1699077511
Name:NGUYEN, PHUONG N (PHARMD)
Entity type:Individual
Prefix:
First Name:PHUONG
Middle Name:N
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 1:4300 NE 4TH ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-5008
Mailing Address - Country:US
Mailing Address - Phone:425-235-6251
Mailing Address - Fax:425-227-9356
Practice Address - Street 1:4300 NE 4TH ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98059-5008
Practice Address - Country:US
Practice Address - Phone:425-235-6251
Practice Address - Fax:425-227-9356
Is Sole Proprietor?:No
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00067865183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist