Provider Demographics
NPI:1891238267
Name:PHAM, XUAN QUYNH
Entity Type:Individual
Prefix:
First Name:XUAN QUYNH
Middle Name:
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 1:254 BYPASS 72 NW
Mailing Address - Street 2:PHARMACY
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649-1509
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:254 BYPASS 72 NW
Practice Address - Street 2:PHARMACY
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649-1509
Practice Address - Country:US
Practice Address - Phone:864-229-1398
Practice Address - Fax:864-229-1620
Is Sole Proprietor?:No
Enumeration Date:2016-12-02
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36894183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist