Provider Demographics
NPI:1023895661
Name:PHAM, ALEXANDER KHANH (PHARMD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:KHANH
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 1:1130 AVENUE OF THE OAKS UNIT 509N
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-4880
Mailing Address - Country:US
Mailing Address - Phone:714-362-7209
Mailing Address - Fax:
Practice Address - Street 1:1695 ROBB DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-3504
Practice Address - Country:US
Practice Address - Phone:775-746-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV23525183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist