Provider Demographics
NPI:1790159937
Name:PHAM, VUONG (PHARM D)
Entity Type:Individual
Prefix:
First Name:VUONG
Middle Name:
Last Name:PHAM
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:KAYENTA
Mailing Address - State:AZ
Mailing Address - Zip Code:86033-0368
Mailing Address - Country:US
Mailing Address - Phone:928-697-4180
Mailing Address - Fax:928-697-4168
Practice Address - Street 1:HWY 160 MP394.3
Practice Address - Street 2:MILE POST 394.3
Practice Address - City:KAYENTA
Practice Address - State:AZ
Practice Address - Zip Code:86033
Practice Address - Country:US
Practice Address - Phone:928-697-4180
Practice Address - Fax:928-697-4168
Is Sole Proprietor?:No
Enumeration Date:2015-11-28
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25522183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist