Provider Demographics
NPI:1912286691
Name:PHAN, OLIVIA A (PHARMD)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:A
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 1:304 SAINT CHARLES WAY
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-4647
Mailing Address - Country:US
Mailing Address - Phone:717-851-5891
Mailing Address - Fax:717-851-5897
Practice Address - Street 1:304 SAINT CHARLES WAY
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-4647
Practice Address - Country:US
Practice Address - Phone:717-851-5891
Practice Address - Fax:717-851-5897
Is Sole Proprietor?:No
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP441688183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist