Provider Demographics
NPI:1497289870
Name:PHAN, TUYET THI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TUYET
Middle Name:THI
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 1:71 HORTON PLZ
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-6144
Mailing Address - Country:US
Mailing Address - Phone:619-231-9361
Mailing Address - Fax:619-231-9552
Practice Address - Street 1:3368 DALEY CENTER DR APT 716
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4614
Practice Address - Country:US
Practice Address - Phone:510-329-5340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75124183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA75124OtherPHARMACIST