Provider Demographics
NPI:1093718181
Name:PHO, QUAN MINH (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:QUAN
Middle Name:MINH
Last Name:PHO
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4467 SW LA PALOMA DR
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-7949
Mailing Address - Country:US
Mailing Address - Phone:772-708-9722
Mailing Address - Fax:
Practice Address - Street 1:1796 HIGHWAY 441 N
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-1918
Practice Address - Country:US
Practice Address - Phone:863-824-2893
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36843183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist