Provider Demographics
NPI:1467083451
Name:PHI, VANESSA VAN
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:VAN
Last Name:PHI
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 1:10600 SOUTHERN HIGHLANDS PKWY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-4368
Mailing Address - Country:US
Mailing Address - Phone:702-254-0823
Mailing Address - Fax:
Practice Address - Street 1:10600 SOUTHERN HIGHLANDS PKWY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89141-4368
Practice Address - Country:US
Practice Address - Phone:702-254-0823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS0242411835P0018X
NV202771835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist