Provider Demographics
NPI:1942594114
Name:PHAN, THU HOANG (BSC)
Entity Type:Individual
Prefix:
First Name:THU
Middle Name:HOANG
Last Name:PHAN
Suffix:
Gender:F
Credentials:BSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6215 SANTA TERESA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119-1436
Mailing Address - Country:US
Mailing Address - Phone:408-227-2816
Mailing Address - Fax:408-227-3204
Practice Address - Street 1:6215 SANTA TERESA BLVD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1436
Practice Address - Country:US
Practice Address - Phone:408-227-2816
Practice Address - Fax:408-227-3204
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60035183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist