MEDICARE: VU THY NGAN PHAN PHARMACIST

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	PS69835	FL

General Provider Information

NPI Number	:	1629933361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VU THY NGAN PHAN PHARMACIST

Provider Business Mailing Address
First Line	:	2050 W COUNTY HIGHWAY 30A # M1-106
Second Line	:
City	:	SANTA ROSA BEACH
State	:	FL
Zip	:	32459-0187
Country	:	US
Telephone Number	:	850-622-3313
Fax Number	:

Provider Business Practice Location Address
First Line	:	2050 W COUNTY HIGHWAY 30A STE 106
Second Line	:
City	:	SANTA ROSA BEACH
State	:	FL
Zip	:	32459-0193
Country	:	US
Telephone Number	:	850-622-3313
Fax Number	:

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

Provider Enumeration Date	:	12/16/2025
Last Update Date	:	12/16/2025

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