Provider Demographics
NPI:1578168159
Name:PHAM, CINDY
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:PHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 ROCHE BROTHERS WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356-1018
Mailing Address - Country:US
Mailing Address - Phone:508-230-0259
Mailing Address - Fax:508-238-6750
Practice Address - Street 1:2 ROCHE BROTHERS WAY
Practice Address - Street 2:
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356-1018
Practice Address - Country:US
Practice Address - Phone:508-230-0259
Practice Address - Fax:508-238-6750
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH24991183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist