Healthcare Provider Details

I. General information

NPI: 1750849881
Provider Name (Legal Business Name): LAVERNE HUYNH-PHAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2019
Last Update Date: 03/07/2019
Certification Date:
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: 559-324-1876
Mailing address:
  • Phone: 559-324-1808
  • Fax: 559-324-1876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY56974
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: