Provider Demographics
NPI:1295284602
Name:PHAN, CASSANDRA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:
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 1:1250 W GROVE PKWY
Mailing Address - Street 2:#1006
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-4435
Mailing Address - Country:US
Mailing Address - Phone:408-207-6096
Mailing Address - Fax:
Practice Address - Street 1:5975 W RAY RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-1827
Practice Address - Country:US
Practice Address - Phone:480-214-9120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS022182183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist