Active NPI
Liem Phan
- Pharmacist
- Holly Hill, FL
National Provider Identifier
1881015576
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS48997
- Practice address
- 1340 Ridgewood Ave
Holly Hill, FL 32117-2320 - Phone
- (386) 615-5079
- NPI assigned
- Dec 23, 2013
- Last updated
- Dec 28, 2013
- 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 | PS48997 | FL | Primary |
Addresses
Primary practice location
1340 Ridgewood Ave
Holly Hill, FL 32117-2320
Mailing address
302 River Bluff Dr
Ormond Beach, FL 32174-3837
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 |
|---|---|---|---|
| PS48997 | FL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1387756800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1388188800000",
"number": "1881015576",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "302 RIVER BLUFF DR",
"city": "ORMOND BEACH",
"state": "FL",
"postal_code": "321743837"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1340 RIDGEWOOD AVE",
"city": "HOLLY HILL",
"state": "FL",
"postal_code": "321172320",
"telephone_number": "386-615-5079"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "LIEM",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-12-23",
"last_updated": "2013-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS48997",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Holly Hill, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.