Provider Demographics
NPI:1992073613
Name:NGUYEN, ANH DEREK (PHARM, D)
Entity type:Individual
Prefix:DR
First Name:ANH
Middle Name:DEREK
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHARM, D
Other - Prefix:DR
Other - First Name:DEREK
Other - Middle Name:LE
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7878 CRESCENT AVE
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-3950
Mailing Address - Country:US
Mailing Address - Phone:714-226-0238
Mailing Address - Fax:714-226-0921
Practice Address - Street 1:7878 CRESCENT AVE
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-3950
Practice Address - Country:US
Practice Address - Phone:714-226-0238
Practice Address - Fax:714-226-0921
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54065183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist