Provider Demographics
NPI:1073987319
Name:PHAM, LENA HANHDUYEN
Entity Type:Individual
Prefix:
First Name:LENA
Middle Name:HANHDUYEN
Last Name:PHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 WOODLAND PKWY
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-3010
Mailing Address - Country:US
Mailing Address - Phone:760-471-9007
Mailing Address - Fax:760-471-9785
Practice Address - Street 1:191 WOODLAND PKWY
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-3010
Practice Address - Country:US
Practice Address - Phone:760-471-9007
Practice Address - Fax:760-471-9785
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-24
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68690183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist