Healthcare Provider Details

I. General information

NPI: 1568298743
Provider Name (Legal Business Name): GRACE P PHAN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2024
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5080 DELHI RD
CINCINNATI OH
45238-5343
US

IV. Provider business mailing address

4403 DELHI RD
CINCINNATI OH
45238-5803
US

V. Phone/Fax

Practice location:
  • Phone: 513-451-7050
  • Fax:
Mailing address:
  • Phone: 513-658-6528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number023606
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03443073
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: