Provider Demographics
NPI:1679600662
Name:NGUYEN, PHUONGANH SIMONE (RPH)
Entity type:Individual
Prefix:MRS
First Name:PHUONGANH
Middle Name:SIMONE
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:PHUONG
Other - Middle Name:ANH
Other - Last Name:NGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:12526 WESTMINSTER AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-2166
Mailing Address - Country:US
Mailing Address - Phone:714-895-2466
Mailing Address - Fax:714-895-9042
Practice Address - Street 1:9302 BOLSA AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5900
Practice Address - Country:US
Practice Address - Phone:714-895-2466
Practice Address - Fax:714-895-9042
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH40895183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist