Provider Demographics
NPI:1063005890
Name:PHUNG, ANH T (RPH)
Entity Type:Individual
Prefix:
First Name:ANH
Middle Name:T
Last Name:PHUNG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:HOANG ANH
Other - Middle Name:T
Other - Last Name:PHUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2541 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-1337
Mailing Address - Country:US
Mailing Address - Phone:215-739-9975
Mailing Address - Fax:215-739-9522
Practice Address - Street 1:2541 KENSINGTON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-1337
Practice Address - Country:US
Practice Address - Phone:215-739-9975
Practice Address - Fax:215-739-9522
Is Sole Proprietor?:No
Enumeration Date:2021-02-12
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP044717L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist