MEDICARE: XUAN PHAN PHARMD

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	73367	CA

General Provider Information

NPI Number	:	1447628961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	XUAN PHAN PHARMD

Provider Business Mailing Address
First Line	:	9135 JUDICIAL DR
Second Line	:	3105
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-4653
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10631 TIERRASANTA BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92124-2605
Country	:	US
Telephone Number	:	858-576-0972
Fax Number	:

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

Provider Enumeration Date	:	09/15/2015
Last Update Date	:	09/15/2015

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Directions to “ XUAN PHAN PHARMD” Practice Location

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