Provider Demographics
NPI:1447580329
Name:PHAM FAMILY PHARMACY INC
Entity Type:Organization
Organization Name:PHAM FAMILY PHARMACY INC
Other - Org Name:PHAM FAMILY PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSSEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-888-8099
Mailing Address - Street 1:14902 PRESTON RD
Mailing Address - Street 2:SUITE 404-513
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-9191
Mailing Address - Country:US
Mailing Address - Phone:214-888-8099
Mailing Address - Fax:214-261-2217
Practice Address - Street 1:11722 MARSH LN STE 343
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75229-2682
Practice Address - Country:US
Practice Address - Phone:210-366-1212
Practice Address - Fax:210-366-1217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-28
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX267483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2123274OtherPK