Provider Demographics
NPI:1871966085
Name:NGUYEN, HAI
Entity type:Individual
Prefix:
First Name:HAI
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 E SANTO ANTONIO DR
Mailing Address - Street 2:259
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-4201
Mailing Address - Country:US
Mailing Address - Phone:717-571-1999
Mailing Address - Fax:
Practice Address - Street 1:1401 E SANTO ANTONIO DR
Practice Address - Street 2:259
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-4201
Practice Address - Country:US
Practice Address - Phone:717-571-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73899183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist