Active NPI
Long Phan, PHARM D
- Pharmacist
- Healdsburg, CA
National Provider Identifier
1801402748
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 81431
- Practice address
- 1375 University St
Healdsburg, CA 95448-3382 - Phone
- (408) 781-4631
- NPI assigned
- Sep 16, 2020
- Last updated
- Sep 16, 2020
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 81431 | CA | Primary |
Addresses
Primary practice location
1375 University St
Healdsburg, CA 95448-3382
Mailing address
3580 W Grant Line Rd Unit 521
Tracy, CA 95304-9614
Phone (408) 781-4631
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 |
|---|---|---|---|
| 81431 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1600214400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1600214400000",
"number": "1801402748",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3580 W GRANT LINE RD UNIT 521",
"city": "TRACY",
"state": "CA",
"postal_code": "953049614",
"telephone_number": "408-781-4631"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1375 UNIVERSITY ST",
"city": "HEALDSBURG",
"state": "CA",
"postal_code": "954483382",
"telephone_number": "408-781-4631"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "LONG",
"credential": "PHARM D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-09-16",
"last_updated": "2020-09-16",
"certification_date": "2020-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "81431",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Healdsburg, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 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.