Provider Demographics
NPI:1821094814
Name:PHAM, HIEN QUY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:HIEN
Middle Name:QUY
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 1:804 E JULIAN ST
Mailing Address - Street 2:STE C
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-1809
Mailing Address - Country:US
Mailing Address - Phone:408-295-6111
Mailing Address - Fax:408-295-6012
Practice Address - Street 1:804 E JULIAN ST
Practice Address - Street 2:STE C
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-1809
Practice Address - Country:US
Practice Address - Phone:408-295-6111
Practice Address - Fax:408-295-6012
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 43795183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY 39440Medicare ID - Type UnspecifiedRETAIL PHARMACY