MEDICARE: PHAT HONG DIEP

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	RP438024	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RP438024	OTHER	PA	STATE LICENSE

General Provider Information

NPI Number	:	1174936389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHAT HONG DIEP

Provider Business Mailing Address
First Line	:	801 S 9TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-2822
Country	:	US
Telephone Number	:	215-925-4481
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 S 9TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-2822
Country	:	US
Telephone Number	:	215-925-4481
Fax Number	:	215-925-4197

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

Provider Enumeration Date	:	06/05/2014
Last Update Date	:	06/05/2014

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Directions to “ PHAT HONG DIEP ” Practice Location

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