MEDICARE: DR. ANGIE HAN OH 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	183500000X	Pharmacist	S015151	AZ

General Provider Information

NPI Number	:	1346510773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGIE HAN OH PHARM.D.

Provider Business Mailing Address
First Line	:	5038 W LARIAT LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85083-1853
Country	:	US
Telephone Number	:	602-318-5155
Fax Number	:

Provider Business Practice Location Address
First Line	:	1646 W MONTEBELLO AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-2557
Country	:	US
Telephone Number	:	602-293-4523
Fax Number	:	602-293-4530

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

Provider Enumeration Date	:	01/02/2012
Last Update Date	:	01/02/2012

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