Provider Demographics
NPI:1407845969
Name:TRAM PHAM PHARMD, INC
Entity Type:Organization
Organization Name:TRAM PHAM PHARMD, INC
Other - Org Name:THU PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-676-3489
Mailing Address - Street 1:15735 HAWTHORNE BLVD #110
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260
Mailing Address - Country:US
Mailing Address - Phone:310-676-3489
Mailing Address - Fax:310-676-7929
Practice Address - Street 1:15735 HAWTHORNE BLVD #110
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260
Practice Address - Country:US
Practice Address - Phone:310-676-3489
Practice Address - Fax:310-676-7929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY40535183500000X
CAPHA 4053503336C0003X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA405350Medicaid
CA1407845969Medicaid