Healthcare Provider Details

I. General information

NPI: 1679430375
Provider Name (Legal Business Name): QUY T PHAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BODIN CIR BLDG 777
TRAVIS AFB CA
94535-1809
US

IV. Provider business mailing address

1200 ALLISON DR APT 5108
VACAVILLE CA
95687-5040
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-2388
  • Fax:
Mailing address:
  • Phone: 603-393-7731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH1001860
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: