Active NPI
Addison Phan, PHARM.D.
- Pharmacist
- Gulfport, MS
National Provider Identifier
1396111407
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- E-13961
- Practice address
- 2433 25TH Ave
Gulfport, MS 39501-4525 - Phone
- (228) 563-6886
- NPI assigned
- Aug 12, 2015
- 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 | E-13961 | MS | Primary |
Addresses
Primary practice location
2433 25TH Ave
Gulfport, MS 39501-4525
Mailing address
10122 Fournier Ave
Diberville, MS 39540-5458
Phone (228) 383-4698
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 |
|---|---|---|---|
| E-13961 | MS | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 1
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": "1439337600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1439337600000",
"number": "1396111407",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10122 FOURNIER AVE",
"city": "DIBERVILLE",
"state": "MS",
"postal_code": "395405458",
"telephone_number": "228-383-4698"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2433 25TH AVE",
"city": "GULFPORT",
"state": "MS",
"postal_code": "395014525",
"telephone_number": "228-563-6886"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "ADDISON",
"credential": "PHARM.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-08-12",
"last_updated": "2015-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MS",
"license": "E-13961",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gulfport, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.