Active NPI
Lynn Thu Phan
- Pharmacist
- Rialto, CA
National Provider Identifier
1679929855
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 70167
- Practice address
- 211 W Base Line Rd
Rialto, CA 92376-3305 - Phone
- (909) 874-8002
- NPI assigned
- May 6, 2016
- Sex
- Female
- Sole proprietor
- Yes
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 | 70167 | CA | Primary |
Addresses
Primary practice location
211 W Base Line Rd
Rialto, CA 92376-3305
Mailing address
6 Skipper
Irvine, CA 92604-1938
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 |
|---|---|---|---|
| 70167 | CA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Garfield Beach CVS, L.L.C. | Past | Accepting new patients | |
| Garfield Beach CVS LLC | 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 and National Provider Directory roles.
-
- Pharmacy
- Rialto, CA
- NPI 1093759367
-
- Pharmacy
- Jurupa Valley, CA
- NPI 1780573113
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1462492800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1462492800000",
"number": "1679929855",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6 SKIPPER",
"city": "IRVINE",
"state": "CA",
"postal_code": "926041938"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "211 W BASE LINE RD",
"city": "RIALTO",
"state": "CA",
"postal_code": "923763305",
"telephone_number": "909-874-8002"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "LYNN THU",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-05-06",
"last_updated": "2016-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "70167",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rialto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.