Provider Demographics
NPI:1811216302
Name:PHAM, KEVIN ANH (RPH)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:ANH
Last Name:PHAM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:HIEP
Other - Middle Name:ANH
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:14097 W ROANOKE AVE
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2480
Mailing Address - Country:US
Mailing Address - Phone:623-236-8669
Mailing Address - Fax:623-236-8669
Practice Address - Street 1:2626 S 83RD AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85043-2125
Practice Address - Country:US
Practice Address - Phone:623-907-2472
Practice Address - Fax:623-907-2472
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-23
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS011232183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist