Provider Demographics
NPI:1891095709
Name:PHAM, MAI THI
Entity Type:Individual
Prefix:
First Name:MAI
Middle Name:THI
Last Name: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 1:771 THORNTON PKWY
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-3680
Mailing Address - Country:US
Mailing Address - Phone:303-280-8218
Mailing Address - Fax:303-452-0563
Practice Address - Street 1:771 THORNTON PKWY
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-3680
Practice Address - Country:US
Practice Address - Phone:303-280-8218
Practice Address - Fax:303-452-0563
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15281183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist