Provider Demographics
NPI:1568298743
Name:PHAN, GRACE P (RPH)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:P
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 1:4403 DELHI RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-5803
Mailing Address - Country:US
Mailing Address - Phone:513-658-6528
Mailing Address - Fax:
Practice Address - Street 1:5080 DELHI RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-5343
Practice Address - Country:US
Practice Address - Phone:513-451-7050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY023606183500000X
OH03443073183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist