Healthcare Provider Details

I. General information

NPI: 1235692864
Provider Name (Legal Business Name): LAVERNE HUYNH-PHAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 W HERNDON AVE STE 101
CLOVIS CA
93612-0381
US

IV. Provider business mailing address

255 W HERNDON AVE STE 101
CLOVIS CA
93612-0381
US

V. Phone/Fax

Practice location:
  • Phone: 559-324-1808
  • Fax:
Mailing address:
  • Phone: 559-324-1808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LAVERNE HUYNH-PHAN
Title or Position: PHARMACIST
Credential: PHARM D
Phone: 559-324-1808