Provider Demographics
NPI:1760083976
Name:PHAM, TUYET VO
Entity Type:Individual
Prefix:
First Name:TUYET
Middle Name:VO
Last Name:PHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 W GIBSON ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TX
Mailing Address - Zip Code:75951-4914
Mailing Address - Country:US
Mailing Address - Phone:409-384-7200
Mailing Address - Fax:409-489-1328
Practice Address - Street 1:800 W GIBSON ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-4914
Practice Address - Country:US
Practice Address - Phone:409-384-7200
Practice Address - Fax:409-489-1328
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34568183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist