MEDICARE: SUSAN PHAN DO PHARMACIST

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	RPH43236	CA
2	183500000X	Pharmacist	PHY40601	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770565079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN PHAN DO PHARMACIST

Provider Business Mailing Address
First Line	:	7245 RESEDA BLVD
Second Line	:	HADO PHARMACY
City	:	RESEDA
State	:	CA
Zip	:	91335-3046
Country	:	US
Telephone Number	:	818-342-9333
Fax Number	:	818-342-9320

Provider Business Practice Location Address
First Line	:	7245 RESEDA BLVD
Second Line	:	HADO PHARMACY
City	:	RESEDA
State	:	CA
Zip	:	91335-3046
Country	:	US
Telephone Number	:	818-342-9333
Fax Number	:	818-342-9320

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

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	07/08/2007

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