Individual
TINA NGUYEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1301 CENTER DR, MEDFORD, OR 97501-7938
(541) 857-4650
Mailing address
3815 SE 122ND AVE APT 8, PORTLAND, OR 97236-3759
(503) 473-5292
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH-0017123
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
93-0798201
INDIVIDUAL
—
Enumeration date
05/29/2019
Last updated
05/29/2019
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