Healthcare Provider Details

I. General information

NPI: 1639469372
Provider Name (Legal Business Name): MINH-THUY THI PHAN REG PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2011
Last Update Date: 04/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 GREENWOOD ST
WORCESTER MA
01607-1728
US

IV. Provider business mailing address

348 GREENWOOD ST
WORCESTER MA
01607-1728
US

V. Phone/Fax

Practice location:
  • Phone: 508-752-1911
  • Fax: 508-752-3553
Mailing address:
  • Phone: 508-752-1911
  • Fax: 508-752-3553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21523
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: