Basic Information
Provider Information
NPI: 1003018433
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NGUYEN
FirstName: TAMMIE
MiddleName: NGOC TU
NamePrefix:  
NameSuffix:  
Credential: PHARM.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8882 HILDRETH LN
Address2:  
City: STOCKTON
State: CA
PostalCode: 952129428
CountryCode: US
TelephoneNumber: 2094739508
FaxNumber:  
Practice Location
Address1: 1205 E NORTH ST
Address2:  
City: MANTECA
State: CA
PostalCode: 953364932
CountryCode: US
TelephoneNumber: 2092398381
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/05/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000X53661CAY Pharmacy Service ProvidersPharmacist 

No ID Information.


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