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General NPI Number Information
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NPI Number | 1902183171
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Entity Type | Individual
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Provider Name | QUANG XUAN PHAN PHARMD
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Gender | Male
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Dates
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Enumeration Date | 11/15/2011
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Last Update Date | 11/15/2011
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Provider Practice Location Address
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Address Line | 16020 PERRIS BLVD
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City | MORENO VALLEY
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State | CA
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Zip | 92551-4618
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Country | US
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Telephone | 951-247-2113
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Fax | 951-247-2762
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Provider Business Mailing Address
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Address Line | 6862 HOP CLOVER RD
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City | CORONA
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State | CA
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Zip | 92880-9144
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Country | US
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Telephone | 714-722-3430
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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 | RPH56604
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License Number State | CA
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