Provider Demographics
NPI:1366254476
Name:LA, PHUONG-ANH (PHARMACIST)
Entity type:Individual
Prefix:
First Name:PHUONG-ANH
Middle Name:
Last Name:LA
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7656 MCGONIGLE TER
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-5627
Mailing Address - Country:US
Mailing Address - Phone:619-808-4738
Mailing Address - Fax:
Practice Address - Street 1:5601 OBERLIN DR STE 124
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3747
Practice Address - Country:US
Practice Address - Phone:858-453-4295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58046183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist