Provider Demographics
NPI:1770830705
Name:PHAM, OANH H (RPH)
Entity Type:Individual
Prefix:MS
First Name:OANH
Middle Name:H
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 1:859 JERICHO PL NE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059
Mailing Address - Country:US
Mailing Address - Phone:425-793-7553
Mailing Address - Fax:
Practice Address - Street 1:20600 108TH AVE SE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031-1536
Practice Address - Country:US
Practice Address - Phone:253-850-0351
Practice Address - Fax:253-850-0784
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00060055183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4928404OtherNCPDP/NABP
WA1841246469OtherNPI
WA4928404OtherNCPDP/NABP