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General NPI Number Information
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NPI Number | 1629586706
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Entity Type | Individual
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Provider Name | KEVIN TAI PHAN
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Gender | Male
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Dates
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Enumeration Date | 01/11/2018
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Last Update Date | 11/28/2021
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Provider Practice Location Address
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Address Line | 1600 N ROSE AVE
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City | OXNARD
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State | CA
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Zip | 93030-3722
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Country | US
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Telephone | 805-988-2735
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 N ROSE AVE
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City | OXNARD
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State | CA
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Zip | 93030-3722
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Country | US
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Telephone | 805-988-2735
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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 | 43243
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 82458
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License Number State | CA
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