Provider Demographics
NPI:1124397625
Name:PHAM, MINH (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MINH
Middle Name:
Last Name:PHAM
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1839 MOLALLA AVE
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-4071
Mailing Address - Country:US
Mailing Address - Phone:503-657-1483
Mailing Address - Fax:503-657-1480
Practice Address - Street 1:4760 LIBERTY RD S
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-5037
Practice Address - Country:US
Practice Address - Phone:503-428-5098
Practice Address - Fax:503-428-5105
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-29
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0012964183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist