Provider Demographics
NPI:1184906307
Name:PHAM, TAN PHUC (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TAN
Middle Name:PHUC
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 1:431 N TUSTIN AVE STE C
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3821
Mailing Address - Country:US
Mailing Address - Phone:714-707-5115
Mailing Address - Fax:714-551-6822
Practice Address - Street 1:431 N TUSTIN AVE STE C
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3821
Practice Address - Country:US
Practice Address - Phone:714-707-5115
Practice Address - Fax:714-551-6822
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64459183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist