Provider Demographics
NPI:1235424102
Name:PHAM, CUONG (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CUONG
Middle Name:
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 1:1600 SARATOGA AVE
Mailing Address - Street 2:T1427
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-5101
Mailing Address - Country:US
Mailing Address - Phone:408-871-9385
Mailing Address - Fax:408-871-9385
Practice Address - Street 1:1600 SARATOGA AVE
Practice Address - Street 2:T1427
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-5101
Practice Address - Country:US
Practice Address - Phone:408-871-9385
Practice Address - Fax:408-871-9385
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH52635183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist