Provider Demographics
NPI:1043592199
Name:PHAM, HOA G (PHARMD)
Entity Type:Individual
Prefix:
First Name:HOA
Middle Name:G
Last Name:PHAM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4038 OLD DENTON RD
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-1020
Mailing Address - Country:US
Mailing Address - Phone:763-670-1277
Mailing Address - Fax:
Practice Address - Street 1:4038 OLD DENTON RD
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-1020
Practice Address - Country:US
Practice Address - Phone:763-670-1277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47779183500000X
MN118553183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist