MEDICARE: LYNH 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	33090	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	13827654	OTHER	TX	TEXAS DRIVER LICENSE

General Provider Information

NPI Number	:	1750995296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNH PHAN

Provider Business Mailing Address
First Line	:	3310 ORLANDO ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77093-4855
Country	:	US
Telephone Number	:	832-582-5700
Fax Number	:

Provider Business Practice Location Address
First Line	:	3310 ORLANDO ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77093-4855
Country	:	US
Telephone Number	:	832-582-5770
Fax Number	:

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

Provider Enumeration Date	:	09/02/2020
Last Update Date	:	09/02/2020

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Directions to “ LYNH PHAN ” Practice Location

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