Provider Demographics
NPI:1952644163
Name:PHAM, NAM Q (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:NAM
Middle Name:Q
Last Name:PHAM
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5125 W FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80219-3605
Mailing Address - Country:US
Mailing Address - Phone:303-936-7403
Mailing Address - Fax:303-937-4426
Practice Address - Street 1:5125 W FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80219-3605
Practice Address - Country:US
Practice Address - Phone:303-936-7403
Practice Address - Fax:303-937-4426
Is Sole Proprietor?:No
Enumeration Date:2013-04-05
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16113183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist