MEDICARE: MS. BACHLAN PHAN RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	0202009558	VA

General Provider Information

NPI Number	:	1013223973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BACHLAN PHAN RPH

Provider Business Mailing Address
First Line	:	6711 RICHMOND HWY
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22306-6712
Country	:	US
Telephone Number	:	703-768-7233
Fax Number	:

Provider Business Practice Location Address
First Line	:	6711 RICHMOND HWY
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22306-6712
Country	:	US
Telephone Number	:	703-768-7233
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2010
Last Update Date	:	08/28/2010

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