Provider Demographics
NPI:1043634215
Name:NGUYEN, AMI (PHARM D)
Entity type:Individual
Prefix:
First Name:AMI
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 S MILITARY TRL
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-7645
Mailing Address - Country:US
Mailing Address - Phone:954-281-3130
Mailing Address - Fax:954-281-3085
Practice Address - Street 1:1101 S MILITARY TRL
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-7645
Practice Address - Country:US
Practice Address - Phone:954-281-3130
Practice Address - Fax:954-281-3085
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-09
Last Update Date:2014-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS51039183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008731800Medicaid
FL1285975441OtherWALMART #3104 NPI
FL5713765OtherNABP WALMART #3104