Provider Demographics
NPI:1487259123
Name:NGUYEN, CHI M
Entity type:Individual
Prefix:
First Name:CHI
Middle Name:M
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5581 MERCHANTS VIEW SQ
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-5439
Mailing Address - Country:US
Mailing Address - Phone:571-248-4551
Mailing Address - Fax:571-248-4555
Practice Address - Street 1:5581 MERCHANTS VIEW SQ
Practice Address - Street 2:
Practice Address - City:HAYMARKET
Practice Address - State:VA
Practice Address - Zip Code:20169-5439
Practice Address - Country:US
Practice Address - Phone:571-248-4551
Practice Address - Fax:571-248-4555
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202204171183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist