Provider Demographics
NPI:1497109490
Name:PHAM, ALLISON R (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:ALLISON
Middle Name:R
Last Name:PHAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10940 SE 187TH LN
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-8113
Mailing Address - Country:US
Mailing Address - Phone:623-282-0359
Mailing Address - Fax:
Practice Address - Street 1:10940 SE 187TH LN
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-8113
Practice Address - Country:US
Practice Address - Phone:623-282-0359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-16
Last Update Date:2016-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60000936183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist