Provider Demographics
NPI:1699284000
Name:PHUONG, NATALIE NGUYEN (RPH)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:NGUYEN
Last Name:PHUONG
Suffix:
Gender:F
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:PO BOX 843
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95106-0843
Mailing Address - Country:US
Mailing Address - Phone:408-786-7244
Mailing Address - Fax:
Practice Address - Street 1:1742 WELCH AVE APT 4
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-2573
Practice Address - Country:US
Practice Address - Phone:408-786-7244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77289183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist