Provider Demographics
NPI:1821374323
Name:PHONG, ANGIE (PHARMD)
Entity Type:Individual
Prefix:MISS
First Name:ANGIE
Middle Name:
Last Name:PHONG
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 1:685 PORTOLA DR
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94127-1207
Mailing Address - Country:US
Mailing Address - Phone:415-504-6200
Mailing Address - Fax:
Practice Address - Street 1:685 PORTOLA DR
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94127-1207
Practice Address - Country:US
Practice Address - Phone:415-504-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 64325183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist