Provider Demographics
NPI:1487789582
Name:PHAN, QUOC HOA (RPH)
Entity type:Individual
Prefix:MR
First Name:QUOC
Middle Name:HOA
Last Name:PHAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:EVAN
Other - Middle Name:
Other - Last Name:PHARMACY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:809 W.CESAR E. CHAVEZ AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012
Mailing Address - Country:US
Mailing Address - Phone:213-626-5228
Mailing Address - Fax:213-607-0504
Practice Address - Street 1:809 W CESAR E CHAVEZ AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-2130
Practice Address - Country:US
Practice Address - Phone:213-626-5228
Practice Address - Fax:213-607-0504
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHA355910183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0597899Medicare ID - Type UnspecifiedNCPDP