Provider Demographics
NPI:1245952571
Name:PHAN, YVONNE Y-VAN NGUYEN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:YVONNE Y-VAN
Middle Name:NGUYEN
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 1:260 N ANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-0184
Mailing Address - Country:US
Mailing Address - Phone:559-392-2608
Mailing Address - Fax:
Practice Address - Street 1:3011 E SHIELDS AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-6752
Practice Address - Country:US
Practice Address - Phone:559-224-2965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86776183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist