Active NPI
Peter Hoa Phan, PHARMD
- Pharmacist
- Camarillo, CA
National Provider Identifier
1073020657
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 71815
- Practice address
- 275 W Ventura Blvd
Camarillo, CA 93010-8359 - Phone
- (805) 233-3631
- Fax
- (805) 233-3379
- NPI assigned
- Jan 4, 2018
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | E-12666 | MS | |
| Pharmacist | 183500000X | 52877 | TX | |
| Pharmacist | 183500000X | 71815 | CA | Primary |
Addresses
Primary practice location
275 W Ventura Blvd
Camarillo, CA 93010-8359
Mailing address
275 W Ventura Blvd
Camarillo, CA 93010-8359
Phone (805) 233-3631
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 |
|---|---|---|---|
| 71815 | CA | MD | Pharmacist |
| E-12666 | MS | MD | Pharmacist |
| 52877 | TX | 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": "1515024000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1515024000000",
"number": "1073020657",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "275 W VENTURA BLVD",
"city": "CAMARILLO",
"state": "CA",
"postal_code": "930108359",
"telephone_number": "805-233-3631",
"fax_number": "805-233-3379"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "275 W VENTURA BLVD",
"city": "CAMARILLO",
"state": "CA",
"postal_code": "930108359",
"telephone_number": "805-233-3631",
"fax_number": "805-233-3379"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "PETER",
"middle_name": "HOA",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-01-04",
"last_updated": "2018-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MS",
"license": "E-12666",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "52877",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "71815",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Camarillo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.