Provider Demographics
NPI:1891870945
Name:PHAM, LY HUONG NGOC (PHARMD)
Entity Type:Individual
Prefix:MISS
First Name:LY HUONG
Middle Name:NGOC
Last Name:PHAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12500 OLD HAMMOND HWY
Mailing Address - Street 2:UNIT D-1
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-1088
Mailing Address - Country:US
Mailing Address - Phone:225-246-8287
Mailing Address - Fax:
Practice Address - Street 1:13555 OLD HAMMOND HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-1161
Practice Address - Country:US
Practice Address - Phone:225-272-8566
Practice Address - Fax:225-272-6005
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17745183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA0556050109Medicare ID - Type UnspecifiedPHARMACY