Provider Demographics
NPI:1407177231
Name:PHAM, JOANNE H (RPH)
Entity Type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:H
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 1:16654 MOUNT BAXTER CIR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-2431
Mailing Address - Country:US
Mailing Address - Phone:714-531-5372
Mailing Address - Fax:
Practice Address - Street 1:7859 FIRESTONE BLVD
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-4220
Practice Address - Country:US
Practice Address - Phone:562-869-8890
Practice Address - Fax:562-861-5418
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45639183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist