Provider Demographics
NPI:1669721858
Name:HAN, PHRAEOPHAN (PHARMD)
Entity type:Individual
Prefix:
First Name:PHRAEOPHAN
Middle Name:
Last Name:HAN
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 1:4211 LAUREL CANYON BLVD APT 109
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-4707
Mailing Address - Country:US
Mailing Address - Phone:818-943-5938
Mailing Address - Fax:
Practice Address - Street 1:13652 CANTARA ST
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-5423
Practice Address - Country:US
Practice Address - Phone:818-375-2417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-03
Last Update Date:2022-05-25
Deactivation Date:2022-03-09
Deactivation Code:
Reactivation Date:2022-05-05
Provider Licenses
StateLicense IDTaxonomies
CA679651835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist