Basic Information
| Provider Information | |||||||||
| NPI: | 1154902732 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NGUYEN | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | VAN | ||||||||
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| Credential: | PHARMD. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4512 W FREEPORT PL | ||||||||
| Address2: | |||||||||
| City: | BROKEN ARROW | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740128660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9182608028 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4101 N MAY AVE | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731126239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052000363 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2021 | ||||||||
| LastUpdateDate: | 04/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 19129 | OK | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.