MEDICARE: CHRISTY PHAN PHARM D

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	43278	TX

General Provider Information

NPI Number	:	1174154173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTY PHAN PHARM D

Provider Business Mailing Address
First Line	:	1203 SAINT MARIA CT
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-8841
Country	:	US
Telephone Number	:	817-917-0823
Fax Number	:

Provider Business Practice Location Address
First Line	:	2580 E ARKANSAS LN
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76014-1706
Country	:	US
Telephone Number	:	817-861-2779
Fax Number	:	817-861-8731

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

Provider Enumeration Date	:	01/28/2020
Last Update Date	:	01/28/2020

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