Provider Demographics
NPI:1710293089
Name:NGUYEN, ANNIE TRAM
Entity type:Individual
Prefix:DR
First Name:ANNIE
Middle Name:TRAM
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 1:2655 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-8918
Mailing Address - Country:US
Mailing Address - Phone:714-838-0677
Mailing Address - Fax:
Practice Address - Street 1:2655 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-8918
Practice Address - Country:US
Practice Address - Phone:714-838-0677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54744183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist