Provider Demographics
NPI:1568061737
Name:PHAM, DIEP NGOC (PHARMD)
Entity Type:Individual
Prefix:
First Name:DIEP
Middle Name:NGOC
Last Name:PHAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:DIEP
Other - Middle Name:NGOC
Other - Last Name:VU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:600 CUMBERLAND PL
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-6633
Mailing Address - Country:US
Mailing Address - Phone:972-409-9798
Mailing Address - Fax:
Practice Address - Street 1:1060 N MAIN ST
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76039-3300
Practice Address - Country:US
Practice Address - Phone:817-283-1152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41483183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist