Provider Demographics
NPI:1235548934
Name:PHAM, DUC
Entity Type:Individual
Prefix:
First Name:DUC
Middle Name:
Last Name:PHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 FLORAL AVE
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:CA
Mailing Address - Zip Code:93662-9036
Mailing Address - Country:US
Mailing Address - Phone:559-891-1960
Mailing Address - Fax:559-891-1962
Practice Address - Street 1:3400 FLORAL AVE
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:CA
Practice Address - Zip Code:93662-9036
Practice Address - Country:US
Practice Address - Phone:559-891-1960
Practice Address - Fax:559-891-1962
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55265183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist