Active NPI
Linh DO Ha Phan, PHARMACIST
- Pharmacist
- Fort Walton Beach, FL
National Provider Identifier
1205447091
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS53979
- Practice address
- 825 Beal Pkwy NW
Fort Walton Beach, FL 32547-1955 - Phone
- (850) 314-0851
- NPI assigned
- Aug 14, 2020
- Last updated
- Aug 14, 2020
- 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 | PS53979 | FL | Primary |
Addresses
Primary practice location
825 Beal Pkwy NW
Fort Walton Beach, FL 32547-1955
Mailing address
2009 Mistral LN E
Fort Walton Beach, FL 32547-7018
Phone (850) 226-1689
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other 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 |
|---|---|---|---|
| PS53979 | FL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1597363200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597363200000",
"number": "1205447091",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2009 MISTRAL LN E",
"city": "FORT WALTON BEACH",
"state": "FL",
"postal_code": "325477018",
"telephone_number": "850-226-1689"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "825 BEAL PKWY NW",
"city": "FORT WALTON BEACH",
"state": "FL",
"postal_code": "325471955",
"telephone_number": "850-314-0851"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "LINH",
"middle_name": "DO HA",
"credential": "PHARMACIST",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-08-14",
"last_updated": "2020-08-14",
"certification_date": "2020-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS53979",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "Na",
"affiliation": "N",
"address_1": "825 Beal Pkwy NW",
"city": "Fort Walton Beach",
"state": "FL",
"country_code": "US",
"postal_code": "325471955",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Fort Walton Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 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.