Provider Demographics
NPI:1720365323
Name:PHAM, QUYEN VAN LE (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:QUYEN
Middle Name:VAN LE
Last Name:PHAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24500 ALICIA PKWY
Mailing Address - Street 2:T0300
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-4508
Mailing Address - Country:US
Mailing Address - Phone:949-583-1278
Mailing Address - Fax:949-583-1278
Practice Address - Street 1:24500 ALICIA PKWY
Practice Address - Street 2:T0300
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-4508
Practice Address - Country:US
Practice Address - Phone:949-583-1278
Practice Address - Fax:949-583-1278
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60767183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist