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General NPI Number Information
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NPI Number | 1114014339
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Entity Type | Organization
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Legal Business Name | PHANLE, INC
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Dates
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Enumeration Date | 10/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2820 ALUM ROCK AVE SUITE 43
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City | SAN JOSE
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State | CA
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Zip | 95127-5608
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Country | US
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Telephone | 408-937-1934
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Fax | 408-937-1475
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Provider Business Mailing Address
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Address Line | 2820 ALUM ROCK AVE SUITE 43
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City | SAN JOSE
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State | CA
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Zip | 95127-5608
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Country | US
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Telephone | 408-937-1934
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Fax | 408-937-1475
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Authorized Official
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Title or Position | SECRETARY
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Name | MR. KIET Q PHAN
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Credential |
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Telephone | 408-569-7948
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 48233
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License Number State | CA
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