Provider Demographics
NPI:1548581580
Name:PHO, DIEU-MAI (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:DIEU-MAI
Middle Name:
Last Name:PHO
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:HELEN
Other - Middle Name:
Other - Last Name:PHO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12421 TOTEM LAKE BLVD NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-7504
Mailing Address - Country:US
Mailing Address - Phone:425-821-1500
Mailing Address - Fax:
Practice Address - Street 1:12421 TOTEM LAKE BLVD NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7504
Practice Address - Country:US
Practice Address - Phone:425-821-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00067771183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist