Provider Demographics
NPI:1558971853
Name:PHAN-CAO, CHARLEEN BAO TRAN (PHARMD)
Entity type:Individual
Prefix:
First Name:CHARLEEN
Middle Name:BAO TRAN
Last Name:PHAN-CAO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:CHARLEEN
Other - Middle Name:BAO TRAN
Other - Last Name:PHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:5820 S 80TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-3813
Mailing Address - Country:US
Mailing Address - Phone:402-617-5956
Mailing Address - Fax:
Practice Address - Street 1:4808 O ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-1908
Practice Address - Country:US
Practice Address - Phone:402-467-1134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE14967183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist