Provider Demographics
NPI:1679873178
Name:PHAM, JENNY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:
Last Name:PHAM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 BELLEVUE WAY NE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-5718
Mailing Address - Country:US
Mailing Address - Phone:425-749-3889
Mailing Address - Fax:425-749-3890
Practice Address - Street 1:300 BELLEVUE WAY NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-5718
Practice Address - Country:US
Practice Address - Phone:425-749-3889
Practice Address - Fax:425-749-3890
Is Sole Proprietor?:No
Enumeration Date:2010-10-30
Last Update Date:2010-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00043379183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist