Provider Demographics
NPI:1235444555
Name:PHAM, THIEN
Entity Type:Individual
Prefix:
First Name:THIEN
Middle Name:
Last Name:PHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUE
Other - Middle Name:
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:807 DAVIDSON DR NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-4351
Mailing Address - Country:US
Mailing Address - Phone:704-786-0135
Mailing Address - Fax:704-786-1018
Practice Address - Street 1:807 DAVIDSON DR NW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-4351
Practice Address - Country:US
Practice Address - Phone:704-786-0135
Practice Address - Fax:704-786-1018
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18196183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist