Individual provider Active NPI

Khanh Quoc Nguyen, RPH

  • Pharmacist
  • Fort Worth, TX
National Provider Identifier
1104539378
Registry record updated Jan 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
36428 Issued in TX
Practice address
4200 Buckingham Rd Ste 105
Fort Worth, TX 76155-2628
Phone
(844) 387-9090
Fax
(833) 288-7942
NPI assigned
Jan 3, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 36428 TX Primary
Pharmacist 183500000X 13497 NE
Pharmacist 183500000X 20999 NV

Addresses

Primary practice location

4200 Buckingham Rd Ste 105
Fort Worth, TX 76155-2628

Mailing address

4200 Buckingham Rd Ste 105
Fort Worth, TX 76155-2628
Phone (844) 387-9090

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
13497NEMDPharmacist
20999NVMDPharmacist
36428TXMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1672704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672704000000",
    "number": "1104539378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4200 BUCKINGHAM RD STE 105",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761552628",
            "telephone_number": "844-387-9090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4200 BUCKINGHAM RD STE 105",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761552628",
            "telephone_number": "844-387-9090",
            "fax_number": "833-288-7942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "KHANH",
        "middle_name": "QUOC",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-01-03",
        "last_updated": "2023-01-03",
        "certification_date": "2023-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "TX",
            "license": "36428",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NE",
            "license": "13497",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NV",
            "license": "20999",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.