Provider Demographics
NPI:1346842366
Name:PHAM, HUNG DOAN (PHARM D)
Entity Type:Individual
Prefix:
First Name:HUNG
Middle Name:DOAN
Last Name:PHAM
Suffix:
Gender:M
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 1:3005 WOODRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762-5232
Mailing Address - Country:US
Mailing Address - Phone:817-504-5441
Mailing Address - Fax:
Practice Address - Street 1:200 W INTERSTATE 20
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-2030
Practice Address - Country:US
Practice Address - Phone:432-684-4425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51772183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist