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General NPI Number Information
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NPI Number | 1275008450
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Entity Type | Individual
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Provider Name | KATHERINE PHAN PHARMD
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Gender | Female
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Dates
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Enumeration Date | 10/04/2018
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Last Update Date | 06/07/2023
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Provider Practice Location Address
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Address Line | 4015 SHOPTON RD STE 600
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City | CHARLOTTE
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State | NC
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Zip | 28217-3025
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Country | US
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Telephone | 855-427-4682
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Fax |
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Provider Business Mailing Address
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Address Line | 240 CULTIVATE
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City | IRVINE
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State | CA
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Zip | 92618-1029
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Country | US
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Telephone |
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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 | 79525
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License Number State | CA
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