Provider Demographics
NPI:1255954996
Name:NGUYEN, JIMMY (PHARMD)
Entity type:Individual
Prefix:
First Name:JIMMY
Middle Name:
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 1:424 W DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-3190
Mailing Address - Country:US
Mailing Address - Phone:312-642-2951
Mailing Address - Fax:312-642-2940
Practice Address - Street 1:424 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-3190
Practice Address - Country:US
Practice Address - Phone:312-642-2951
Practice Address - Fax:312-642-2940
Is Sole Proprietor?:No
Enumeration Date:2020-05-28
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051303622183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist