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General NPI Number Information
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NPI Number | 1043193394
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Entity Type | Individual
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Provider Name | JACKIE HANG PHAN PHARMACIST
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Gender | Female
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Dates
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Enumeration Date | 07/25/2025
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Last Update Date | 07/25/2025
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Provider Practice Location Address
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Address Line | 6750 W THUNDERBIRD RD
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City | PEORIA
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State | AZ
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Zip | 85381-5026
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Country | US
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Telephone | 623-209-0870
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Fax |
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Provider Business Mailing Address
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Address Line | 19801 N 59TH AVE UNIT 10127
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City | GLENDALE
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State | AZ
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Zip | 85318-5007
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Country | US
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Telephone | 623-826-7748
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | S010547
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License Number State | AZ
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