Provider Demographics
NPI:1861779316
Name:NGUYEN, PHUONG DIEU (PHARM D)
Entity type:Individual
Prefix:
First Name:PHUONG
Middle Name:DIEU
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3604 KEE LN
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-8662
Mailing Address - Country:US
Mailing Address - Phone:209-380-0338
Mailing Address - Fax:
Practice Address - Street 1:3500 COFFEE RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-1305
Practice Address - Country:US
Practice Address - Phone:209-341-0814
Practice Address - Fax:209-341-0849
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-11
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48747183500000X
NV13425183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist