Provider Demographics
NPI:1306381546
Name:PHAM, ANH
Entity Type:Individual
Prefix:MR
First Name:ANH
Middle Name:
Last Name:PHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ANH
Other - Middle Name:
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:11701 METCALF AVE
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2202
Mailing Address - Country:US
Mailing Address - Phone:913-338-1849
Mailing Address - Fax:
Practice Address - Street 1:11701 METCALF AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2202
Practice Address - Country:US
Practice Address - Phone:913-338-1849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-26
Last Update Date:2016-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-12223183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist