Provider Demographics
NPI:1467798181
Name:PHAM, TUAN A
Entity Type:Individual
Prefix:MR
First Name:TUAN
Middle Name:A
Last Name:PHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 GREENBRIAR ST
Mailing Address - Street 2:STE 235
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-5294
Mailing Address - Country:US
Mailing Address - Phone:713-521-1700
Mailing Address - Fax:713-521-5855
Practice Address - Street 1:4101 GREENBRIAR ST.
Practice Address - Street 2:STE 235
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098
Practice Address - Country:US
Practice Address - Phone:713-521-1700
Practice Address - Fax:713-521-5855
Is Sole Proprietor?:No
Enumeration Date:2012-12-28
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41660183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist