Provider Demographics
NPI:1639511918
Name:PHAN, UYEN (CPHT)
Entity Type:Individual
Prefix:
First Name:UYEN
Middle Name:
Last Name:PHAN
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3819 S ANGEL PL
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-3131
Mailing Address - Country:US
Mailing Address - Phone:206-954-5344
Mailing Address - Fax:
Practice Address - Street 1:3819 S ANGEL PL
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-3131
Practice Address - Country:US
Practice Address - Phone:206-954-5344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA60393754183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician