Provider Demographics
NPI:1558972455
Name:PHAM, THIEN-AN THI (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:THIEN-AN
Middle Name:THI
Last Name:PHAM
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18910 US HIGHWAY 441
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-6736
Mailing Address - Country:US
Mailing Address - Phone:352-735-0600
Mailing Address - Fax:352-735-4205
Practice Address - Street 1:18910 US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-6736
Practice Address - Country:US
Practice Address - Phone:352-735-0600
Practice Address - Fax:352-735-4205
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS53816183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist