Active NPI
Marissa Phan
- Pharmacist
- San Leandro, CA
National Provider Identifier
1902227481
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 66269
- Practice address
- 15555 E. 14TH Street #400
San Leandro, CA 94578 - Phone
- (510) 276-2699
- NPI assigned
- Dec 30, 2013
- 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 | 66269 | CA | Primary |
Addresses
Primary practice location
15555 E. 14TH Street #400
San Leandro, CA 94578
Mailing address
4809 Cornflower Street
San Ramon, CA 94582
Phone (214) 907-1633
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1388361600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1388361600000",
"number": "1902227481",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4809 CORNFLOWER STREET",
"city": "SAN RAMON",
"state": "CA",
"postal_code": "94582",
"telephone_number": "214-907-1633"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15555 E. 14TH STREET #400",
"city": "SAN LEANDRO",
"state": "CA",
"postal_code": "94578",
"telephone_number": "510-276-2699"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "MARISSA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-12-30",
"last_updated": "2013-12-30",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "66269",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Leandro, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 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.