Provider Demographics
NPI:1881212371
Name:NGUYEN, NGAN T
Entity type:Individual
Prefix:
First Name:NGAN
Middle Name:T
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 1:161 E. PRAIRIE SHOPPING CENTER
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835
Mailing Address - Country:US
Mailing Address - Phone:208-772-7864
Mailing Address - Fax:
Practice Address - Street 1:2929 E 29TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-4811
Practice Address - Country:US
Practice Address - Phone:509-535-9056
Practice Address - Fax:509-535-0823
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2025-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP8866183500000X
WAPH61050058183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist