Provider Demographics
NPI:1245778554
Name:PHAN, NGOC-THAO THI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NGOC-THAO
Middle Name:THI
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 1:2121 DOUGLAS ST APT 707
Mailing Address - Street 2:WESTBROOK TOWER APT 707
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-1244
Mailing Address - Country:US
Mailing Address - Phone:402-730-5623
Mailing Address - Fax:
Practice Address - Street 1:2121 DOUGLAS ST APT 707
Practice Address - Street 2:WESTBROOK TOWER APT 707
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-1244
Practice Address - Country:US
Practice Address - Phone:402-730-5623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE136801835P0018X, 1835P1200X, 1835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care