Provider Demographics
NPI:1982827127
Name:PHAM, JOCELYN (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:
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 1:30828 GANADO DRIVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-6242
Mailing Address - Country:US
Mailing Address - Phone:619-820-4146
Mailing Address - Fax:
Practice Address - Street 1:13141 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-4416
Practice Address - Country:US
Practice Address - Phone:310-675-9322
Practice Address - Fax:310-675-9322
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 56578183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist