Provider Demographics
NPI:1194547406
Name:PHAN, KIM LOAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:LOAN
Last Name:PHAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 VETERANS BLVD
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-2734
Mailing Address - Country:US
Mailing Address - Phone:504-834-1570
Mailing Address - Fax:
Practice Address - Street 1:1401 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-2734
Practice Address - Country:US
Practice Address - Phone:504-834-1570
Practice Address - Fax:504-833-9148
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.025535183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist