Healthcare Provider Details

I. General information

NPI: 1093718181
Provider Name (Legal Business Name): QUAN MINH PHO PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1796 HIGHWAY 441 N
OKEECHOBEE FL
34972-1918
US

IV. Provider business mailing address

4467 SW LA PALOMA DR
PALM CITY FL
34990-7949
US

V. Phone/Fax

Practice location:
  • Phone: 863-824-2893
  • Fax:
Mailing address:
  • Phone: 772-708-9722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS36843
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: