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General NPI Number Information
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NPI Number | 1104150747
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Entity Type | Individual
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Provider Name | BRIAN X PHAN PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 09/30/2009
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Last Update Date | 11/22/2021
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Provider Practice Location Address
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Address Line | 30116 EIGENBRODT WAY
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City | UNION CITY
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State | CA
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Zip | 94587-1225
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Country | US
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Telephone | 510-675-6792
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Fax |
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Provider Business Mailing Address
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Address Line | 7153 CALERO HILLS CT
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City | SAN JOSE
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State | CA
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Zip | 95139-1512
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Country | US
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Telephone | 408-234-8448
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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 | RPH 61165
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License Number State | CA
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