Provider Demographics
NPI:1437581923
Name:PHAN, ROSS (PHARMD, BCPS)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:
Last Name:PHAN
Suffix:
Gender:F
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7656 REGAL LN
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-0150
Mailing Address - Country:US
Mailing Address - Phone:805-391-7974
Mailing Address - Fax:
Practice Address - Street 1:7656 REGAL LN
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-0150
Practice Address - Country:US
Practice Address - Phone:805-391-7974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064899183500000X
SC42437183500000X
MI5302411608183500000X, 1835P0018X
OH03440361183500000X
COPHA.0020484183500000X, 1835P0018X
MD27000183500000X, 1835P0018X
WI20573183500000X, 1835P0018X
DEA10005494183500000X, 1835P0018X
TX533581835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist