Healthcare Provider Details

I. General information

NPI: 1629933361
Provider Name (Legal Business Name): VU THY NGAN PHAN PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 W COUNTY HIGHWAY 30A STE 106
SANTA ROSA BEACH FL
32459-0193
US

IV. Provider business mailing address

2050 W COUNTY HIGHWAY 30A # M1-106
SANTA ROSA BEACH FL
32459-0187
US

V. Phone/Fax

Practice location:
  • Phone: 850-622-3313
  • Fax:
Mailing address:
  • Phone: 850-622-3313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS69835
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: