1386678654 NPI number — MISS TRAM THI-PHUONG NGUYEN PHARMACIST

Table of content: MISS TRAM THI-PHUONG NGUYEN PHARMACIST (NPI 1386678654)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386678654 NPI number — MISS TRAM THI-PHUONG NGUYEN PHARMACIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NGUYEN
Provider First Name:
TRAM
Provider Middle Name:
THI-PHUONG
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
PHARMACIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NGUYEN
Provider Other First Name:
TRAM
Provider Other Middle Name:
THI-PHUONG
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMACIST
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1386678654
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
332 MANILLA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DRAPER
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84020-5111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-582-1565
Provider Business Mailing Address Fax Number:
801-584-2530

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 FOOTHILL BLVD
Provider Second Line Business Practice Location Address:
OP119
Provider Business Practice Location Address City Name:
SLC
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84148-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-582-1565
Provider Business Practice Location Address Fax Number:
801-584-2530
Provider Enumeration Date:
07/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  14995 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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