Provider Demographics
NPI:1811470669
Name:NGUYEN, THAO NU PHUONG (PHARMD)
Entity type:Individual
Prefix:
First Name:THAO
Middle Name:NU PHUONG
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:THAO
Other - Middle Name:NU PHUONG
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:15602 31ST PL W
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-2515
Mailing Address - Country:US
Mailing Address - Phone:425-772-6118
Mailing Address - Fax:
Practice Address - Street 1:707 S 56TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-5617
Practice Address - Country:US
Practice Address - Phone:253-471-1730
Practice Address - Fax:253-471-3529
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60867738183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH60867738OtherWASHINGTON STATE DEPARTMENT OF HEALTH