Provider Demographics
NPI:1497239388
Name:PHAM, TRUNG THU (PHARMD)
Entity Type:Individual
Prefix:
First Name:TRUNG THU
Middle Name:
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 1:1539 SARA LN
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-4185
Mailing Address - Country:US
Mailing Address - Phone:713-391-0461
Mailing Address - Fax:
Practice Address - Street 1:2955 GULF FWY S
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-6750
Practice Address - Country:US
Practice Address - Phone:281-337-5210
Practice Address - Fax:281-337-5274
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX71762183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program