Provider Demographics
NPI:1902612203
Name:HOLTON-NGUYENTAN, DUCANHHOA-CRYSTAL (PHARMD)
Entity type:Individual
Prefix:
First Name:DUCANHHOA-CRYSTAL
Middle Name:
Last Name:HOLTON-NGUYENTAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:DUCANHHOA-CRYSTAL
Other - Middle Name:
Other - Last Name:NGUYENTAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:626 PERALTA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-5738
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:505 PARNASSUS AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2204
Practice Address - Country:US
Practice Address - Phone:209-471-3250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85027183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist