Provider Demographics
NPI:1306836358
Name:PHAN, SUSIE N (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SUSIE
Middle Name:N
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 1:10402 WESTMINSTER AVE # C
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-4861
Mailing Address - Country:US
Mailing Address - Phone:714-534-4133
Mailing Address - Fax:714-534-4052
Practice Address - Street 1:10402 WESTMINSTER AVE # C
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-4861
Practice Address - Country:US
Practice Address - Phone:714-534-4133
Practice Address - Fax:714-534-4052
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2012-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55443183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist