Provider Demographics
NPI:1326322652
Name:PHAM, CATHY PHUONG (PHARM-D)
Entity Type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:PHUONG
Last Name:PHAM
Suffix:
Gender:F
Credentials:PHARM-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95818-2219
Mailing Address - Country:US
Mailing Address - Phone:916-440-0953
Mailing Address - Fax:916-440-0957
Practice Address - Street 1:1401 BROADWAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95818-2219
Practice Address - Country:US
Practice Address - Phone:916-440-0953
Practice Address - Fax:916-440-0957
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA564892183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist