Provider Demographics
NPI:1699111708
Name:NGUYEN, DONG G (RPH)
Entity type:Individual
Prefix:MR
First Name:DONG
Middle Name:G
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 1:7210 K4 HWY STE A
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:KS
Mailing Address - Zip Code:66512-9389
Mailing Address - Country:US
Mailing Address - Phone:785-484-3784
Mailing Address - Fax:785-484-3688
Practice Address - Street 1:7210 K4 HWY STE A
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:KS
Practice Address - Zip Code:66512-9389
Practice Address - Country:US
Practice Address - Phone:785-484-3784
Practice Address - Fax:785-484-3688
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-12485183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100438660BMedicaid