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General NPI Number Information
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NPI Number | 1497564066
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Entity Type | Individual
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Provider Name | TIMOTHY PHAN
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Gender | Male
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Dates
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Enumeration Date | 01/07/2025
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 3950 W GRAND PKWY N
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City | KATY
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State | TX
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Zip | 77449-2398
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Country | US
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Telephone | 281-574-5407
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Fax |
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Provider Business Mailing Address
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Address Line | 11710 DALHOUSIE DR
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City | RICHMOND
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State | TX
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Zip | 77407-3315
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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 | 75235
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License Number State | TX
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