Provider Demographics
NPI:1043653165
Name:NGUYEN, TUNG THANH (R PH)
Entity type:Individual
Prefix:
First Name:TUNG
Middle Name:THANH
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15109 E COLFAX AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-5729
Mailing Address - Country:US
Mailing Address - Phone:303-343-3170
Mailing Address - Fax:303-365-0961
Practice Address - Street 1:15109 E COLFAX AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-5729
Practice Address - Country:US
Practice Address - Phone:303-343-3170
Practice Address - Fax:303-365-0961
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13546183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist