Mimi Thanh-Uyen Phan, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

0202204354 Issued in VA

Practice address

9300 Dewitt Loop
Ft Belvoir, VA 22060-5285

Phone

(571) 231-2887

NPI assigned

Jan 14, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1578960000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578960000000",
    "number": "1013557388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9300 DEWITT LOOP",
            "city": "FT BELVOIR",
            "state": "VA",
            "postal_code": "220605285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9300 DEWITT LOOP",
            "city": "FT BELVOIR",
            "state": "VA",
            "postal_code": "220605285",
            "telephone_number": "571-231-2887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "MIMI",
        "middle_name": "THANH-UYEN",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-14",
        "last_updated": "2020-01-14",
        "certification_date": "2020-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CA",
            "license": "52496",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "VA",
            "license": "0202204354",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "email",
            "affiliation": "N",
            "address_1": "9300 DeWitt Loop",
            "city": "Ft Belvoir",
            "state": "VA",
            "country_code": "US",
            "postal_code": "220605285",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Natasha Ariana Petrackis, M.D.
• Rachel Savitri Petwal, LCSW
• Cathy Elizabeth Peuterbaugh, CRNA
• Kimanh Thi Pham, PHARM.D.
• Jessica Phan, PHARMD
• Jennifer Rachelle Pickinpaugh-Inocencio, D.O.
• Emily Pierce, MD
• Melissa Mae Pietras, PA-C
• Elizabeth F Pillsbury, LICSW
• Shauna Southard Pittman

• Pharmacist in Ft Belvoir, VA
• Providers in Ft Belvoir, VA by specialty
• Pharmacist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.