Provider Demographics
NPI:1518273473
Name:PHAM-TRAN, BICH VAN THI (PHARMD)
Entity Type:Individual
Prefix:
First Name:BICH VAN
Middle Name:THI
Last Name:PHAM-TRAN
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 1:3723 LINDA VISTA AVE NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-4192
Mailing Address - Country:US
Mailing Address - Phone:505-507-9057
Mailing Address - Fax:
Practice Address - Street 1:2709 PAN AMERICAN FWY NE STE G
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-1650
Practice Address - Country:US
Practice Address - Phone:505-341-4739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-29
Last Update Date:2010-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00007543183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist