Healthcare Provider Details

I. General information

NPI: 1740944537
Provider Name (Legal Business Name): MY HANH PHUNG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2021
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W BIRCH ST
CALEXICO CA
92231-2348
US

IV. Provider business mailing address

3351 WATERCREST CT
BONITA CA
91902-2221
US

V. Phone/Fax

Practice location:
  • Phone: 760-768-3169
  • Fax:
Mailing address:
  • Phone: 858-380-8667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number84911
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: