Provider Demographics
NPI:1285948307
Name:PHAN, BACH THU MINH (RPH)
Entity type:Individual
Prefix:
First Name:BACH THU
Middle Name:MINH
Last Name:PHAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 S 11TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-3701
Mailing Address - Country:US
Mailing Address - Phone:215-768-3102
Mailing Address - Fax:215-923-2082
Practice Address - Street 1:907 S 11TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-3701
Practice Address - Country:US
Practice Address - Phone:215-923-1469
Practice Address - Fax:215-925-3884
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02042000183500000X
PARP035451L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist