Basic Information
| Provider Information | |||||||||
| NPI: | 1356615405 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NGUYEN | ||||||||
| FirstName: | PHUONG | ||||||||
| MiddleName: | ANH | ||||||||
| NamePrefix: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | NGUYEN | ||||||||
| OtherFirstName: | SUE | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7802 ROSE GARDEN LN | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221532367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035691218 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9300 DEWITT LOOP | ||||||||
| Address2: | |||||||||
| City: | FORT BELVOIR | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5712313224 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2012 | ||||||||
| LastUpdateDate: | 03/06/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 0202012989 | VA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.