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NPI Code Detail

MEDICARE: RANDY PHAN PHARM D.

MEDICARE: RANDY 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
1183500000XPharmacistS015142AZ

General Provider Information

NPI Number : 1407168958
Entity Type Code : Individual
Provider Name (Legal Business Name) : RANDY PHAN PHARM D.
Provider Business Mailing Address
First Line : 520 E BASELINE RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85042-6554
Country : US
Telephone Number : 602-243-3014
Fax Number : 602-305-9092
Provider Business Practice Location Address
First Line : 520 E BASELINE RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85042-6554
Country : US
Telephone Number : 602-243-3014
Fax Number : 602-305-9092
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2010
Last Update Date : 07/12/2010

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