Provider Demographics
NPI:1841577632
Name:PHAN, DOQUYEN H (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DOQUYEN
Middle Name:H
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 1:533 COLEMAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95110-2047
Mailing Address - Country:US
Mailing Address - Phone:408-623-9060
Mailing Address - Fax:
Practice Address - Street 1:533 COLEMAN AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95110-2047
Practice Address - Country:US
Practice Address - Phone:408-623-9060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55343183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist