Provider Demographics
NPI:1598280026
Name:PHAM, THAO THI (PHARMD)
Entity Type:Individual
Prefix:
First Name:THAO
Middle Name:THI
Last Name:PHAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9055 KATY FWY STE 200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-1629
Mailing Address - Country:US
Mailing Address - Phone:713-373-3300
Mailing Address - Fax:713-461-0561
Practice Address - Street 1:9055 KATY FWY STE 101
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-1663
Practice Address - Country:US
Practice Address - Phone:713-373-3300
Practice Address - Fax:713-461-0561
Is Sole Proprietor?:No
Enumeration Date:2017-08-05
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX54166183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist