Provider Demographics
NPI:1255648333
Name:PHAM, THUAN BINH (PHARMD)
Entity type:Individual
Prefix:
First Name:THUAN
Middle Name:BINH
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 1:1221 CLOS DUVAL
Mailing Address - Street 2:
Mailing Address - City:BONSALL
Mailing Address - State:CA
Mailing Address - Zip Code:92003-6114
Mailing Address - Country:US
Mailing Address - Phone:760-941-4094
Mailing Address - Fax:760-728-0387
Practice Address - Street 1:1221 S MISSION RD
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-4005
Practice Address - Country:US
Practice Address - Phone:760-728-6063
Practice Address - Fax:760-726-0387
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH42030183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPH42030OtherCALIFORNIA STATE BOARD OF PHARMACY