Provider Demographics
NPI:1841560539
Name:NGUYEN-PHAM, VAN-GIANG
Entity Type:Individual
Prefix:
First Name:VAN-GIANG
Middle Name:
Last Name:NGUYEN-PHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 LAKESHORE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-2720
Mailing Address - Country:US
Mailing Address - Phone:510-271-0843
Mailing Address - Fax:510-271-0849
Practice Address - Street 1:3250 LAKESHORE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-2720
Practice Address - Country:US
Practice Address - Phone:510-271-0843
Practice Address - Fax:510-271-0849
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH56511183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist