Active NPI
Christine Luu Phan
- Pharmacist
- Pocatello, ID
National Provider Identifier
1861065476
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- P9479
- Practice address
- 235 S 4TH Ave
Pocatello, ID 83201-6438 - Phone
- (208) 233-3341
- NPI assigned
- Jul 21, 2021
- 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 | P9479 | ID | Primary |
Addresses
Primary practice location
235 S 4TH Ave
Pocatello, ID 83201-6438
Mailing address
4170 Hawthorne Rd Apt A202
Pocatello, ID 83202-2710
Phone (949) 683-8823
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT 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 |
|---|---|---|---|
| P9479 | ID | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1626825600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1626825600000",
"number": "1861065476",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4170 HAWTHORNE RD APT A202",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832022710",
"telephone_number": "949-683-8823"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "235 S 4TH AVE",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832016438",
"telephone_number": "208-233-3341"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "CHRISTINE",
"middle_name": "LUU",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-07-21",
"last_updated": "2021-07-21",
"certification_date": "2021-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "ID",
"license": "P9479",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "NA",
"affiliation": "N",
"address_1": "235 S 4th Ave",
"city": "Pocatello",
"state": "ID",
"country_code": "US",
"postal_code": "832016438",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Pocatello, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.