Provider Demographics
NPI:1598064362
Name:PHAM, NGA (PHARM D)
Entity Type:Individual
Prefix:
First Name:NGA
Middle Name:
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 1:11129 GORDON RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-1714
Mailing Address - Country:US
Mailing Address - Phone:540-785-6634
Mailing Address - Fax:540-785-6671
Practice Address - Street 1:11129 GORDON RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-1714
Practice Address - Country:US
Practice Address - Phone:540-785-6634
Practice Address - Fax:540-785-6671
Is Sole Proprietor?:No
Enumeration Date:2011-03-19
Last Update Date:2011-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202010919183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist