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General NPI Number Information
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NPI Number | 1972335743
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Entity Type | Individual
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Provider Name | DUSTIN L PHAN PHARMD
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Gender | Male
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Dates
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Enumeration Date | 08/19/2024
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Last Update Date | 08/19/2024
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Provider Practice Location Address
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Address Line | 2500 MERCED ST
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City | SAN LEANDRO
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State | CA
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Zip | 94577-4201
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Country | US
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Telephone | 510-454-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 17927 HEMMINGWAY ST
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City | RESEDA
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State | CA
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Zip | 91335-2108
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Country | US
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Telephone | 818-668-7644
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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 | 1835P2201X
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Taxonomy Name | Ambulatory Care Pharmacist
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License Number | RPH87519
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License Number State | CA
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