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General NPI Number Information
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NPI Number | 1376643353
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Entity Type | Organization
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Legal Business Name | PHUONG H DO
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 05/01/2009
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Provider Practice Location Address
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Address Line | 600 WASHINGTON AVE UNIT# 18E
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City | PHILADELPHIA
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State | PA
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Zip | 19147-4836
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Country | US
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Telephone | 215-755-5100
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Fax | 215-755-1055
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Provider Business Mailing Address
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Address Line | 600 WASHINGTON AVE UNIT# 18E
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City | PHILADELPHIA
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State | PA
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Zip | 19147-4836
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Country | US
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Telephone | 215-755-5100
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Fax | 215-755-1055
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | DR. TRISSIE DIEM NGUYEN
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Credential | R.PH.
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Telephone | 215-755-5100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | PP481360
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License Number State | PA
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