Provider Demographics
NPI:1396045290
Name:PHAM, PHUONG BICH
Entity Type:Individual
Prefix:MRS
First Name:PHUONG
Middle Name:BICH
Last Name:PHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 PIDGEON HILL DR
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-6130
Mailing Address - Country:US
Mailing Address - Phone:703-430-4355
Mailing Address - Fax:703-430-6610
Practice Address - Street 1:30 PIDGEON HILL DR
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-6130
Practice Address - Country:US
Practice Address - Phone:703-430-4355
Practice Address - Fax:703-430-6610
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202204968183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist