Healthcare Provider Details

I. General information

NPI: 1194217919
Provider Name (Legal Business Name): THANH NGOC PHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 E SHAW
PASADENA TX
77506
US

IV. Provider business mailing address

927 E SHAW
PASADENA TX
77506
US

V. Phone/Fax

Practice location:
  • Phone: 713-982-5168
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number48793
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: