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General NPI Number Information
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NPI Number | 1811620545
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Entity Type | Individual
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Provider Name | KEVIN BUI PHAN
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Gender | Male
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Dates
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Enumeration Date | 07/09/2022
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Last Update Date | 07/09/2022
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Provider Practice Location Address
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Address Line | 18611 EASTFIELD DR
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City | WEBSTER
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State | TX
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Zip | 77598-1303
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Country | US
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Telephone | 281-488-0179
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Fax | 281-282-9764
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Provider Business Mailing Address
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Address Line | 18611 EASTFIELD DR
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City | WEBSTER
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State | TX
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Zip | 77598-1303
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Country | US
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Telephone | 281-488-0179
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Fax | 281-282-9764
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 310585
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License Number State | TX
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