Provider Demographics
NPI:1255940367
Name:PHAM, CONG (PHARMD)
Entity type:Individual
Prefix:MR
First Name:CONG
Middle Name:
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 1:28550 HIGHWAY 290
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-4288
Mailing Address - Country:US
Mailing Address - Phone:281-256-6490
Mailing Address - Fax:281-256-6546
Practice Address - Street 1:28550 HIGHWAY 290
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-4288
Practice Address - Country:US
Practice Address - Phone:281-256-6490
Practice Address - Fax:281-256-6546
Is Sole Proprietor?:No
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51933183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist