Provider Demographics
NPI:1962748889
Name:NGUYEN, MAI-HONG THY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MAI-HONG
Middle Name:THY
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 SE 22ND AVE
Mailing Address - Street 2:MAILSTOP 04002/34K
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-2918
Mailing Address - Country:US
Mailing Address - Phone:503-797-7144
Mailing Address - Fax:187-737-6948
Practice Address - Street 1:3800 SE 22ND AVE
Practice Address - Street 2:MAILSTOP 04002/34K
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-2918
Practice Address - Country:US
Practice Address - Phone:503-797-7144
Practice Address - Fax:187-737-6948
Is Sole Proprietor?:No
Enumeration Date:2012-12-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-00132581835P0018X
OR0013258183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist