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NPI Code Detail

MEDICARE: DR. JOHN VAN PHARM D

MEDICARE: DR. JOHN VAN PHARM D
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
1183500000XPharmacist61623CA

General Provider Information

NPI Number : 1902177728
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN VAN PHARM D
Provider Business Mailing Address
First Line : 3222 UNIVERSITY AVENUE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92104
Country : US
Telephone Number : 619-528-1793
Fax Number : 619-528-1797
Provider Business Practice Location Address
First Line : 3222 UNIVERSITY AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92104-2010
Country : US
Telephone Number : 619-528-1793
Fax Number : 619-528-1797
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2012
Last Update Date : 01/25/2012

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