Provider Demographics
NPI:1972890887
Name:NGUYEN, MAI N (RPH)
Entity type:Individual
Prefix:
First Name:MAI
Middle Name:N
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 1:5106 SAWGRASS DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-5037
Mailing Address - Country:US
Mailing Address - Phone:214-530-0184
Mailing Address - Fax:214-530-0184
Practice Address - Street 1:601 S PLANO RD
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-4512
Practice Address - Country:US
Practice Address - Phone:214-530-0184
Practice Address - Fax:214-530-0184
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32393183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1568484228OtherPHARMACY