Provider Demographics
NPI:1730316704
Name:PHAM, LIEN THUY (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:LIEN
Middle Name:THUY
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 1:550 TECHNOLOGY PARK
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-7131
Mailing Address - Country:US
Mailing Address - Phone:407-865-7795
Mailing Address - Fax:407-936-1034
Practice Address - Street 1:550 TECHNOLOGY PARK
Practice Address - Street 2:SUITE 1000
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-7131
Practice Address - Country:US
Practice Address - Phone:407-865-7795
Practice Address - Fax:407-936-1034
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS27737183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS27737OtherPHARMACIST LICENSE
FL022363800Medicaid
FL3893420001Medicare NSC