Provider Demographics
NPI:1982934113
Name:PHAN, ERIC H (PHARMD)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:H
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 1:14516 BROOKHURST ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5750
Mailing Address - Country:US
Mailing Address - Phone:714-531-5502
Mailing Address - Fax:714-531-8425
Practice Address - Street 1:14516 BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5750
Practice Address - Country:US
Practice Address - Phone:714-531-5502
Practice Address - Fax:714-531-8425
Is Sole Proprietor?:No
Enumeration Date:2010-01-11
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS015201183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist