Provider Demographics
NPI:1740944537
Name:PHUNG, MY HANH (PHARMD)
Entity type:Individual
Prefix:
First Name:MY
Middle Name:HANH
Last Name:PHUNG
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 1:3351 WATERCREST CT
Mailing Address - Street 2:
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902-2221
Mailing Address - Country:US
Mailing Address - Phone:858-380-8667
Mailing Address - Fax:
Practice Address - Street 1:221 W BIRCH ST
Practice Address - Street 2:
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231-2348
Practice Address - Country:US
Practice Address - Phone:760-768-3169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-27
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84911183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist