Provider Demographics
NPI:1174844716
Name:VO, MICHELLE PHUONGANH (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:PHUONGANH
Last Name:VO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32261 MISSION TRL
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-4577
Mailing Address - Country:US
Mailing Address - Phone:951-674-0301
Mailing Address - Fax:951-674-8621
Practice Address - Street 1:32261 MISSION TRL
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-4577
Practice Address - Country:US
Practice Address - Phone:951-674-0301
Practice Address - Fax:951-674-8621
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54499183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist