Provider Demographics
NPI:1720432149
Name:DO, VAN (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:VAN
Middle Name:
Last Name:DO
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 1:650 GATEWAY CENTER DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-4530
Mailing Address - Country:US
Mailing Address - Phone:619-358-2302
Mailing Address - Fax:
Practice Address - Street 1:650 GATEWAY CENTER DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-4530
Practice Address - Country:US
Practice Address - Phone:619-358-2302
Practice Address - Fax:619-358-2310
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA650741835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist