Provider Demographics
NPI:1922384452
Name:PHAN, CHRIS QUOC (PHARMACIST)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:QUOC
Last Name:PHAN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 MCCART AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-3628
Mailing Address - Country:US
Mailing Address - Phone:817-924-2666
Mailing Address - Fax:
Practice Address - Street 1:3100 MCCART AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-3628
Practice Address - Country:US
Practice Address - Phone:817-924-2666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42903183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist