Provider Demographics
NPI:1962771949
Name:NGUYEN, KIMBERLY TRANG (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:TRANG
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 1:11655 ARNOLD PALMER DR
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-5498
Mailing Address - Country:US
Mailing Address - Phone:763-208-5996
Mailing Address - Fax:
Practice Address - Street 1:3470 RIVER RAPIDS DR NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55448-4101
Practice Address - Country:US
Practice Address - Phone:763-427-1156
Practice Address - Fax:763-427-1562
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117669183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist