Active NPI
Lien My Thi Phan, PHARM.D
- Pharmacist
- Eglin Afb, FL
National Provider Identifier
1104989391
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS41114
- Practice address
- 307 Boatner Rd
Eglin Afb, FL 32542-1391 - Phone
- (850) 279-6510
- Fax
- (850) 883-8429
- NPI assigned
- Dec 18, 2006
- 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 | PS41114 | FL | Primary |
Addresses
Primary practice location
307 Boatner Rd
Eglin Afb, FL 32542-1391
Mailing address
307 Boatner Rd
Eglin Afb, FL 32542-1391
Phone (850) 279-6510
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 |
|---|---|---|---|
| PS41114 | FL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193270400000",
"number": "1104989391",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "307 BOATNER RD",
"city": "EGLIN AFB",
"state": "FL",
"postal_code": "325421391",
"telephone_number": "850-279-6510",
"fax_number": "850-883-8429"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "307 BOATNER RD",
"city": "EGLIN AFB",
"state": "FL",
"postal_code": "325421391",
"telephone_number": "850-279-6510",
"fax_number": "850-883-8429"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "LIEN",
"middle_name": "MY THI",
"name_prefix": "Mrs.",
"credential": "PHARM.D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-18",
"last_updated": "2007-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS41114",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eglin Afb, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.