Provider Demographics
NPI:1285224253
Name:PHAM, HOANG MINH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:HOANG
Middle Name:MINH
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 1:4511 MURIETTA AVE UNIT 7
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-2993
Mailing Address - Country:US
Mailing Address - Phone:510-691-0255
Mailing Address - Fax:
Practice Address - Street 1:6735 VALJEAN AVE
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-5819
Practice Address - Country:US
Practice Address - Phone:818-304-0881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79801183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist