Provider Demographics
NPI:1437432432
Name:PHAM, LARRY (PHARMD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:PHAM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1873 W LANTANA RD
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33462-2601
Mailing Address - Country:US
Mailing Address - Phone:561-533-5522
Mailing Address - Fax:561-586-3487
Practice Address - Street 1:1873 W LANTANA RD
Practice Address - Street 2:
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-2601
Practice Address - Country:US
Practice Address - Phone:561-533-5522
Practice Address - Fax:561-586-3487
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41741183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist