Provider Demographics
NPI:1174097109
Name:NGUYEN, TRINH MINH (PHARMD)
Entity type:Individual
Prefix:
First Name:TRINH
Middle Name:MINH
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2328 ETCHEVERRY DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95212-3038
Mailing Address - Country:US
Mailing Address - Phone:916-662-6291
Mailing Address - Fax:
Practice Address - Street 1:7720 LORRAINE AVE STE 102
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-4203
Practice Address - Country:US
Practice Address - Phone:209-957-8787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-12
Last Update Date:2019-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78888183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist