Provider Demographics
NPI:1912993304
Name:NGUYEN, NGA THI (RPH)
Entity type:Individual
Prefix:MRS
First Name:NGA
Middle Name:THI
Last Name:NGUYEN
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 1:8736 VALLEY BLVD
Mailing Address - Street 2:#A
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-1760
Mailing Address - Country:US
Mailing Address - Phone:626-288-4165
Mailing Address - Fax:626-288-2376
Practice Address - Street 1:8736 VALLEY BLVD
Practice Address - Street 2:#A
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1760
Practice Address - Country:US
Practice Address - Phone:626-288-4165
Practice Address - Fax:626-288-2376
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH43222183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA365540Medicaid