Provider Demographics
NPI:1205157336
Name:PHAM, KHANHTRAM T (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KHANHTRAM
Middle Name:T
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 1:2135 COWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-6388
Mailing Address - Country:US
Mailing Address - Phone:530-753-9810
Mailing Address - Fax:530-753-4569
Practice Address - Street 1:2135 COWELL BLVD
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95618-6388
Practice Address - Country:US
Practice Address - Phone:530-753-9810
Practice Address - Fax:530-753-4569
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56790183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist