Provider Demographics
NPI:1043941701
Name:NGUYEN, QUANG NHAT (PHARMACIST INTERN)
Entity type:Individual
Prefix:
First Name:QUANG
Middle Name:NHAT
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHARMACIST INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7901 HIGHWAY 290 W
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78736-3259
Mailing Address - Country:US
Mailing Address - Phone:512-288-5713
Mailing Address - Fax:855-211-5844
Practice Address - Street 1:7901 HIGHWAY 290 W
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78736-3259
Practice Address - Country:US
Practice Address - Phone:512-288-5713
Practice Address - Fax:855-211-5844
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42213183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician