Provider Demographics
NPI:1053167346
Name:BUI, ANGEL XUAN-NGUYEN
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:XUAN-NGUYEN
Last Name:BUI
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 1:3451 HERITAGE TRACE PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177-7505
Mailing Address - Country:US
Mailing Address - Phone:817-232-8632
Mailing Address - Fax:682-708-1783
Practice Address - Street 1:3451 HERITAGE TRACE PKWY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76177-7505
Practice Address - Country:US
Practice Address - Phone:817-232-8632
Practice Address - Fax:682-708-1783
Is Sole Proprietor?:No
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX297859183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician