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General NPI Number Information
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NPI Number | 1629933361
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Entity Type | Individual
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Provider Name | VU THY NGAN PHAN PHARMACIST
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Gender | Female
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Dates
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Enumeration Date | 12/16/2025
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Last Update Date | 12/16/2025
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Provider Practice Location Address
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Address Line | 2050 W COUNTY HIGHWAY 30A STE 106
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City | SANTA ROSA BEACH
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State | FL
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Zip | 32459-0193
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Country | US
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Telephone | 850-622-3313
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Fax |
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Provider Business Mailing Address
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Address Line | 2050 W COUNTY HIGHWAY 30A # M1-106
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City | SANTA ROSA BEACH
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State | FL
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Zip | 32459-0187
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Country | US
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Telephone | 850-622-3313
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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 | PS69835
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License Number State | FL
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