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NPI Code Detail

MEDICARE: DR. PHUC THANH PHAN RPH

MEDICARE: DR. PHUC THANH PHAN RPH
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
1183500000XPharmacist83629CA

General Provider Information

NPI Number : 1356939094
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PHUC THANH PHAN RPH
Provider Business Mailing Address
First Line : 77710 MARLOWE CT
Second Line :
City : PALM DESERT
State : CA
Zip : 92211-6213
Country : US
Telephone Number : 714-510-6596
Fax Number :
Provider Business Practice Location Address
First Line : 42155 WASHINGTON ST
Second Line :
City : PALM DESERT
State : CA
Zip : 92211-8006
Country : US
Telephone Number : 760-345-3259
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/07/2021
Last Update Date : 01/15/2026

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