MEDICARE: HOANG DUNG 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	67453	TX

General Provider Information

NPI Number	:	1790388361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOANG DUNG PHAN

Provider Business Mailing Address
First Line	:	2301 E WACO DR
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76705-3207
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2301 E WACO DR
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76705-3207
Country	:	US
Telephone Number	:	254-799-5412
Fax Number	:

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

Provider Enumeration Date	:	11/17/2020
Last Update Date	:	11/17/2020

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Directions to “ HOANG DUNG PHAN ” Practice Location

Language	Start Address	Practice Location

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