Individual provider Active NPI

Mai Thanh Nguyen, PHARM D.

  • Pharmacist
  • Fairfax, VA
National Provider Identifier
1871197749
Registry record updated Nov 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
0202204856 Issued in VA
Practice address
11003 Lee Hwy
Fairfax, VA 22030-5002
Phone
(571) 432-5801
Fax
(571) 432-5807
NPI assigned
Nov 22, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 22, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PharmacistGroup: 193200000X MULTI-SPECIALTY GROUP 183500000X 0202204856 VA Primary

Addresses

Primary practice location

11003 Lee Hwy
Fairfax, VA 22030-5002

Mailing address

4711 Logwood LN
Chantilly, VA 20151-2459
Phone (703) 217-0674

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
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
0202204856VAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Virginia CVS Pharmacy, L.L.C. PastSince Nov 29, 2020 Accepting new patients
Virginia CVS Pharmacy, L.L.C. PastSince Nov 29, 2020 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1606003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606003200000",
    "number": "1871197749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4711 LOGWOOD LN",
            "city": "CHANTILLY",
            "state": "VA",
            "postal_code": "201512459",
            "telephone_number": "703-217-0674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11003 LEE HWY",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220305002",
            "telephone_number": "571-432-5801",
            "fax_number": "571-432-5807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "MAI",
        "middle_name": "THANH",
        "credential": "PHARM D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-11-22",
        "last_updated": "2020-11-22",
        "certification_date": "2020-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pharmacist",
            "state": "VA",
            "license": "0202204856",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfax, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2020; 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.