Provider Demographics
NPI:1114014339
Name:PHANLE, INC
Entity Type:Organization
Organization Name:PHANLE, INC
Other - Org Name:GET WELL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:KIET
Authorized Official - Middle Name:Q
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-569-7948
Mailing Address - Street 1:2820 ALUM ROCK AVE
Mailing Address - Street 2:SUITE 43
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95127-5608
Mailing Address - Country:US
Mailing Address - Phone:408-937-1934
Mailing Address - Fax:408-937-1475
Practice Address - Street 1:2820 ALUM ROCK AVE
Practice Address - Street 2:SUITE 43
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-5608
Practice Address - Country:US
Practice Address - Phone:408-937-1934
Practice Address - Fax:408-937-1475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA482333336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy