Provider Demographics
NPI:1922260926
Name:PHAM, MINHHA THI (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MINHHA
Middle Name:THI
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 1:4697 STILLWELL RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-4566
Mailing Address - Country:US
Mailing Address - Phone:805-937-7655
Mailing Address - Fax:
Practice Address - Street 1:1120 E CLARK AVE
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-5123
Practice Address - Country:US
Practice Address - Phone:805-934-4002
Practice Address - Fax:805-934-4782
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45670183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist