Provider Demographics
NPI:1396392445
Name:PHAM, MICHAEL NHAN VO (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:MICHAEL NHAN
Middle Name:VO
Last Name:PHAM
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8203 W ORAIBI DR APT 1105
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-4690
Mailing Address - Country:US
Mailing Address - Phone:209-323-9044
Mailing Address - Fax:
Practice Address - Street 1:4965 W BELL RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3418
Practice Address - Country:US
Practice Address - Phone:602-843-2305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-23
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS024206183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist