Provider Demographics
NPI:1063703114
Name:NGUYEN, MY-NGA THI (PHARM D)
Entity type:Individual
Prefix:
First Name:MY-NGA
Middle Name:THI
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 1:17915 33RD PL W
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-7734
Mailing Address - Country:US
Mailing Address - Phone:425-787-8565
Mailing Address - Fax:
Practice Address - Street 1:17915 33RD PL W
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-7734
Practice Address - Country:US
Practice Address - Phone:425-787-8565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60177849183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist