Provider Demographics
NPI:1639859887
Name:PHAM, YEN HAI NGUYEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:YEN
Middle Name:HAI NGUYEN
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 1:79 E PRINCETON DR APT C210
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-1247
Mailing Address - Country:US
Mailing Address - Phone:773-366-1539
Mailing Address - Fax:
Practice Address - Street 1:1174 W 600 N
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84116-2676
Practice Address - Country:US
Practice Address - Phone:801-363-1047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13453004-1721183500000X
NV23794183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist