Provider Demographics
NPI:1013288745
Name:PHAN, QUYNH-DAO NGUYEN (PHARM D)
Entity Type:Individual
Prefix:
First Name:QUYNH-DAO
Middle Name:NGUYEN
Last Name:PHAN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S PLANO RD
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-4512
Mailing Address - Country:US
Mailing Address - Phone:214-530-0184
Mailing Address - Fax:214-530-0184
Practice Address - Street 1:601 S PLANO RD
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-4512
Practice Address - Country:US
Practice Address - Phone:214-530-0184
Practice Address - Fax:214-530-0184
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41256183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist