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General NPI Number Information
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NPI Number | 1679430375
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Entity Type | Individual
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Provider Name | QUY T PHAN PHARMD
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Gender | Male
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Dates
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Enumeration Date | 01/06/2026
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | 101 BODIN CIR BLDG 777
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City | TRAVIS AFB
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State | CA
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Zip | 94535-1809
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Country | US
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Telephone | 707-423-2388
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 ALLISON DR APT 5108
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City | VACAVILLE
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State | CA
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Zip | 95687-5040
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Country | US
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Telephone | 603-393-7731
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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 | PH1001860
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License Number State | MA
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