Provider Demographics
NPI:1396182754
Name:PHAN, TUY Q
Entity Type:Individual
Prefix:
First Name:TUY
Middle Name:Q
Last Name:PHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-1719
Mailing Address - Country:US
Mailing Address - Phone:610-937-7817
Mailing Address - Fax:
Practice Address - Street 1:113 E BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:19018-1603
Practice Address - Country:US
Practice Address - Phone:610-622-3225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-25
Last Update Date:2013-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP438075183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist