Provider Demographics
NPI:1457858144
Name:PHAM, ANDREW NGOC-MINH (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:NGOC-MINH
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 1:11311 LA GRANGE AVE APT 230
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6866
Mailing Address - Country:US
Mailing Address - Phone:714-363-7146
Mailing Address - Fax:
Practice Address - Street 1:8510 BALBOA BLVD STE 150
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-5810
Practice Address - Country:US
Practice Address - Phone:818-654-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79307183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist