MEDICARE: SUNG PHAN R.PH

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	R57136	CA

General Provider Information

NPI Number	:	1679966287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUNG PHAN R.PH

Provider Business Mailing Address
First Line	:	19781 RINALDI ST
Second Line	:
City	:	PORTER RANCH
State	:	CA
Zip	:	91326-4143
Country	:	US
Telephone Number	:	818-832-5955
Fax Number	:

Provider Business Practice Location Address
First Line	:	19781 RINALDI ST
Second Line	:
City	:	PORTER RANCH
State	:	CA
Zip	:	91326-4143
Country	:	US
Telephone Number	:	818-832-5955
Fax Number	:

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

Provider Enumeration Date	:	03/07/2015
Last Update Date	:	03/07/2015

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