Provider Demographics
NPI:1164973822
Name:PHAM, TRACY (PHARMD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:PHAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7302 ROCKMONT AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-6125
Mailing Address - Country:US
Mailing Address - Phone:714-548-8551
Mailing Address - Fax:562-599-5292
Practice Address - Street 1:1750 PACIFIC AVE # A
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-1715
Practice Address - Country:US
Practice Address - Phone:562-599-5292
Practice Address - Fax:562-599-1893
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA591071835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care