Active NPI
Timothy Phan, PHARM D
- Pharmacist
- La Puente, CA
National Provider Identifier
1023575735
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 80237
- Practice address
- 1425 N Hacienda Blvd
La Puente, CA 91744-1133 - Phone
- (626) 251-1906
- NPI assigned
- Feb 28, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 80237 | CA | Primary |
Addresses
Primary practice location
1425 N Hacienda Blvd
La Puente, CA 91744-1133
Mailing address
1425 N Hacienda Blvd
La Puente, CA 91744-1133
Phone (626) 251-1906
Other names 1
- Tue Phan
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 80237 | CA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walmart Inc. | Past | Accepting new patients | |
| Walmart Inc. | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1551312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1551312000000",
"number": "1023575735",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1425 N HACIENDA BLVD",
"city": "LA PUENTE",
"state": "CA",
"postal_code": "917441133",
"telephone_number": "626-251-1906"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1425 N HACIENDA BLVD",
"city": "LA PUENTE",
"state": "CA",
"postal_code": "917441133",
"telephone_number": "626-251-1906"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "TIMOTHY",
"credential": "PHARM D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-02-28",
"last_updated": "2019-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "80237",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "TUE",
"last_name": "PHAN",
"code": "5",
"type": "Other Name"
}
]
}Other providers in La Puente, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.