MEDICARE: NGAN N PHAN

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	0202209248	VA

General Provider Information

NPI Number	:	1578168563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NGAN N PHAN

Provider Business Mailing Address
First Line	:	9121 THORTON WAY
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-4164
Country	:	US
Telephone Number	:	804-677-4342
Fax Number	:

Provider Business Practice Location Address
First Line	:	5100 S LABURNUM AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23231-4410
Country	:	US
Telephone Number	:	804-222-7827
Fax Number	:

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

Provider Enumeration Date	:	11/30/2020
Last Update Date	:	11/30/2020

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