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General NPI Number Information
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NPI Number | 1992073860
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Entity Type | Individual
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Provider Name | TAMMY PHAN
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Gender | Female
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Dates
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Enumeration Date | 12/07/2011
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Last Update Date | 12/07/2011
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Provider Practice Location Address
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Address Line | 1826 W ORANGETHROPE AVE
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City | FULLERTON
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State | CA
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Zip | 92833
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Country | US
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Telephone | 714-526-9257
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Fax |
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Provider Business Mailing Address
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Address Line | 9371 IMPERIAL AVE
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City | GARDEN
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State | CA
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Zip | 92844-2314
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Country | US
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Telephone | 714-326-4865
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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 | 54292
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License Number State | CA
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