Provider Demographics
NPI:1376886705
Name:PHAM, LETHI BUI (RPH)
Entity Type:Individual
Prefix:
First Name:LETHI
Middle Name:BUI
Last Name:PHAM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13742 NEWLAND ST
Mailing Address - Street 2:#24
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-2525
Mailing Address - Country:US
Mailing Address - Phone:714-903-4302
Mailing Address - Fax:
Practice Address - Street 1:24276 166TH STREET
Practice Address - Street 2:CHEYENNE RIVER HEALTH UNIT
Practice Address - City:EAGLE BUTTE
Practice Address - State:SD
Practice Address - Zip Code:57625
Practice Address - Country:US
Practice Address - Phone:605-964-0650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-04
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302037864183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist