Individual
TAM PHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1625 SCHRADER BLVD FL 1, LOS ANGELES, CA 90028-6213
(323) 993-7513
Mailing address
1150 W JEFFERSON BLVD # 150, LOS ANGELES, CA 90089-3604
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
78948
CA
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Primary
78948
CA
1835P2201X
Ambulatory Care Pharmacist
78948
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1910UAVS
—
CA
Enumeration date
09/24/2018
Last updated
03/02/2020
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