Provider Demographics
NPI:1629264643
Name:PHAM, RICHARD HOANG (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:HOANG
Last Name:PHAM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 HARVARD ST SE # 7-192
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0353
Mailing Address - Country:US
Mailing Address - Phone:623-363-2529
Mailing Address - Fax:
Practice Address - Street 1:308 HARVARD ST SE # 7-192
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0353
Practice Address - Country:US
Practice Address - Phone:612-625-5448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14186183500000X
MN118215183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist