Healthcare Provider Details

I. General information

NPI: 1174936389
Provider Name (Legal Business Name): PHAT HONG DIEP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 06/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S 9TH ST
PHILADELPHIA PA
19147-2822
US

IV. Provider business mailing address

801 S 9TH ST
PHILADELPHIA PA
19147-2822
US

V. Phone/Fax

Practice location:
  • Phone: 215-925-4481
  • Fax: 215-925-4197
Mailing address:
  • Phone: 215-925-4481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP438024
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: