Provider Demographics
NPI:1912139403
Name:PHAN, CHAU THANH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHAU
Middle Name:THANH
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 1:35867 ARGONNE ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-1700
Mailing Address - Country:US
Mailing Address - Phone:510-299-2512
Mailing Address - Fax:
Practice Address - Street 1:1101 WELCH RD STE C12
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1928
Practice Address - Country:US
Practice Address - Phone:650-326-2300
Practice Address - Fax:650-326-2351
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62912183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist