Provider Demographics
NPI:1346409901
Name:PHAN, NHUNG THANH
Entity Type:Individual
Prefix:
First Name:NHUNG
Middle Name:THANH
Last Name:PHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 W WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-3621
Mailing Address - Country:US
Mailing Address - Phone:562-694-4367
Mailing Address - Fax:562-694-4754
Practice Address - Street 1:1700 W WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-3621
Practice Address - Country:US
Practice Address - Phone:562-694-4367
Practice Address - Fax:562-694-4754
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-08
Last Update Date:2008-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43138183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist