Provider Demographics
NPI:1902688823
Name:HA, ANDY NGUYEN (PHARMD)
Entity type:Individual
Prefix:
First Name:ANDY
Middle Name:NGUYEN
Last Name:HA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 N HURON DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-3137
Mailing Address - Country:US
Mailing Address - Phone:714-417-3392
Mailing Address - Fax:
Practice Address - Street 1:1605 N HURON DR
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-3137
Practice Address - Country:US
Practice Address - Phone:714-417-3392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH88188183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist