Provider Demographics
NPI:1225682925
Name:PHAN, CHAU NGOC THANH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHAU
Middle Name:NGOC THANH
Last Name:PHAN
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 1:9191 WESTMINSTER AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-2751
Mailing Address - Country:US
Mailing Address - Phone:714-899-1111
Mailing Address - Fax:
Practice Address - Street 1:9191 WESTMINSTER AVE STE 108
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-2751
Practice Address - Country:US
Practice Address - Phone:714-899-1111
Practice Address - Fax:714-899-2808
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45046183500000X, 163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Multi-Specialty