Provider Demographics
NPI:1871843003
Name:PHAM, CANH MINH (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:CANH
Middle Name:MINH
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 1:1100 N MERIDIAN
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-4403
Mailing Address - Country:US
Mailing Address - Phone:253-840-8183
Mailing Address - Fax:253-840-8177
Practice Address - Street 1:1100 N MERIDIAN
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-4403
Practice Address - Country:US
Practice Address - Phone:253-840-8183
Practice Address - Fax:253-840-8177
Is Sole Proprietor?:No
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00022358183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist