Provider Demographics
NPI:1871978478
Name:NGUYEN, MADELINE QUYEN (PHARMD)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:QUYEN
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5504 ELIZABETH ROSE SQ
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-6601
Mailing Address - Country:US
Mailing Address - Phone:757-362-8508
Mailing Address - Fax:
Practice Address - Street 1:5504 ELIZABETH ROSE SQ
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-6601
Practice Address - Country:US
Practice Address - Phone:757-362-8508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2020-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202214234183500000X
FLPS54475183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0202214234OtherLICENSE
FLPS54475OtherREGISTERED PHARMACIST