Active NPI
Carly Rose Phan
- Pharmacist
- Lanham, MD
National Provider Identifier
1104591841
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 28145
- Practice address
- 4551 Forbes Blvd
Lanham, MD 20706-4325 - Phone
- (301) 918-6500
- NPI assigned
- Aug 13, 2021
- Sex
- Female
- 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 | 28145 | MD | Primary |
Addresses
Primary practice location
4551 Forbes Blvd
Lanham, MD 20706-4325
Mailing address
4551 Forbes Blvd
Lanham, MD 20706-4325
Phone (301) 918-6500
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | NA |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28145 | MD | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1628812800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1628812800000",
"number": "1104591841",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4551 FORBES BLVD",
"city": "LANHAM",
"state": "MD",
"postal_code": "207064325",
"telephone_number": "301-918-6500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4551 FORBES BLVD",
"city": "LANHAM",
"state": "MD",
"postal_code": "207064325",
"telephone_number": "301-918-6500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "CARLY",
"middle_name": "ROSE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-08-13",
"last_updated": "2021-08-13",
"certification_date": "2021-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MD",
"license": "28145",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "NA",
"affiliation": "N",
"address_1": "4551 Forbes Blvd",
"city": "Lanham",
"state": "MD",
"country_code": "US",
"postal_code": "207064325",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Lanham, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.