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General NPI Number Information
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NPI Number | 1538617006
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Entity Type | Individual
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Provider Name | SUSAN LE PHAN
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Gender | Female
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Dates
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Enumeration Date | 09/14/2016
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Last Update Date | 09/29/2016
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Provider Practice Location Address
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Address Line | 8432 MIDDLETOWN LN
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City | WESTMINSTER
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State | CA
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Zip | 92683-4544
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Country | US
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Telephone | 714-404-0860
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Fax |
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Provider Business Mailing Address
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Address Line | 4001 HALLMARK PKWY
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City | SAN BERNARDINO
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State | CA
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Zip | 92407-1876
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Country | US
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Telephone | 909-880-4038
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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 | 72007
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License Number State | CA
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