Provider Demographics
NPI:1821343906
Name:PHAM, TUONG N (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TUONG
Middle Name:N
Last Name:PHAM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:973 HIGHWAY 90 E
Mailing Address - Street 2:
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70380-5156
Mailing Address - Country:US
Mailing Address - Phone:985-395-9625
Mailing Address - Fax:
Practice Address - Street 1:973 HIGHWAY 90 E
Practice Address - Street 2:
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-5156
Practice Address - Country:US
Practice Address - Phone:985-395-9625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA19828183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist