Provider Demographics
NPI:1841569860
Name:PHAM, THUY THANH (RPH)
Entity Type:Individual
Prefix:
First Name:THUY
Middle Name:THANH
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 1:10990 WARNER AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-3849
Mailing Address - Country:US
Mailing Address - Phone:714-962-7200
Mailing Address - Fax:714-965-0469
Practice Address - Street 1:10990 WARNER AVE
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-3849
Practice Address - Country:US
Practice Address - Phone:714-962-7200
Practice Address - Fax:714-965-0469
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53964183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist