Provider Demographics
NPI:1003190976
Name:PHAM, BRIAN DINH (RPH)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:DINH
Last Name:PHAM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5296 JIMMY CARTER BLVD
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-1603
Mailing Address - Country:US
Mailing Address - Phone:770-798-9355
Mailing Address - Fax:770-798-9975
Practice Address - Street 1:5296 JIMMY CARTER BLVD
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-1603
Practice Address - Country:US
Practice Address - Phone:770-798-9355
Practice Address - Fax:770-798-9975
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH022479183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist