MEDICARE: MR. HUNG PHI PHAN 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	RPH45283	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	:	1790782175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HUNG PHI PHAN PHARMACIST

Provider Business Mailing Address
First Line	:	702 E SANTA CLARA ST
Second Line	:	SUITE #1
City	:	SAN JOSE
State	:	CA
Zip	:	95112-1920
Country	:	US
Telephone Number	:	408-275-0858
Fax Number	:	408-275-0859

Provider Business Practice Location Address
First Line	:	702 E SANTA CLARA ST
Second Line	:	SUITE #1
City	:	SAN JOSE
State	:	CA
Zip	:	95112-1920
Country	:	US
Telephone Number	:	408-275-0858
Fax Number	:	408-275-0859

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	07/08/2007

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