Provider Demographics
NPI:1447483698
Name:NGUYEN, NGOCTHAO HAI (RPH)
Entity type:Individual
Prefix:
First Name:NGOCTHAO
Middle Name:HAI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:891 SE 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-3811
Mailing Address - Country:US
Mailing Address - Phone:503-266-6381
Mailing Address - Fax:503-266-6751
Practice Address - Street 1:891 SE 1ST AVE
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-3811
Practice Address - Country:US
Practice Address - Phone:503-266-6381
Practice Address - Fax:503-266-6751
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9525183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist