MEDICARE: MISS DUNG NGOC PHAN R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH 47041	CA
2	3336C0003X	Community/Retail Pharmacy	RPH47041	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073518627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS DUNG NGOC PHAN R.PH.

Provider Business Mailing Address
First Line	:	4776 EL CAJON BLVD
Second Line	:	STE 105
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-4521
Country	:	US
Telephone Number	:	619-287-1206
Fax Number	:

Provider Business Practice Location Address
First Line	:	4776 EL CAJON BLVD
Second Line	:	STE 105
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-4521
Country	:	US
Telephone Number	:	619-287-1206
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	03/11/2022

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