Provider Demographics
NPI:1104046143
Name:PHAM, THOA NGOC (RPH)
Entity Type:Individual
Prefix:MRS
First Name:THOA
Middle Name:NGOC
Last Name:PHAM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22ND MEDICAL GROUP
Mailing Address - Street 2:57950 LEAVENWORTH
Mailing Address - City:MCCONNELL AFB
Mailing Address - State:KS
Mailing Address - Zip Code:67221-3506
Mailing Address - Country:US
Mailing Address - Phone:316-759-5277
Mailing Address - Fax:
Practice Address - Street 1:104 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-3128
Practice Address - Country:US
Practice Address - Phone:603-332-9360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3196183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist