Provider Demographics
NPI:1922375625
Name:PHAM, RYAN HUY (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:HUY
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 1:10212 BELLEHURST AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5779
Mailing Address - Country:US
Mailing Address - Phone:714-724-3256
Mailing Address - Fax:
Practice Address - Street 1:12001 EUCLID ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-3332
Practice Address - Country:US
Practice Address - Phone:714-530-1071
Practice Address - Fax:714-530-2637
Is Sole Proprietor?:No
Enumeration Date:2011-11-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54808183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist