Active NPI
Brian Vu Phan, PHARMD
- Pharmacist
- Moreno Valley, CA
National Provider Identifier
1366920894
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 76982
- Practice address
- 26520 Cactus Ave
Moreno Valley, CA 92555-3927 - Phone
- (951) 486-6608
- NPI assigned
- Aug 6, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051301257 | IL | |
| Pharmacist | 183500000X | 76982 | CA | Primary |
Addresses
Primary practice location
26520 Cactus Ave
Moreno Valley, CA 92555-3927
Mailing address
26520 Cactus Ave
Moreno Valley, CA 92555-3927
Phone (951) 486-6608
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 |
|---|---|---|---|
| 76982 | CA | MD | Pharmacist |
| 051301257 | IL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1533513600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1672185600000",
"number": "1366920894",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26520 CACTUS AVE",
"city": "MORENO VALLEY",
"state": "CA",
"postal_code": "925553927",
"telephone_number": "951-486-6608"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26520 CACTUS AVE",
"city": "MORENO VALLEY",
"state": "CA",
"postal_code": "925553927",
"telephone_number": "951-486-6608"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "BRIAN",
"middle_name": "VU",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-08-06",
"last_updated": "2022-12-28",
"certification_date": "2022-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051301257",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "76982",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moreno Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.