Provider Demographics
NPI:1972976561
Name:NGUYEN-SUEKAWA, LAN A,
Entity type:Individual
Prefix:
First Name:LAN
Middle Name:A,
Last Name:NGUYEN-SUEKAWA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3081 STEVENS CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-6704
Mailing Address - Country:US
Mailing Address - Phone:408-241-5141
Mailing Address - Fax:408-243-8312
Practice Address - Street 1:3081 STEVENS CREEK BLVD
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-6704
Practice Address - Country:US
Practice Address - Phone:408-241-5141
Practice Address - Fax:408-243-8312
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46263183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist