Provider Demographics
NPI:1336422724
Name:PHAM, UYEN THI (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:UYEN
Middle Name:THI
Last Name:PHAM
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON HIGHLANDS
Mailing Address - State:MA
Mailing Address - Zip Code:02461-1101
Mailing Address - Country:US
Mailing Address - Phone:617-332-6880
Mailing Address - Fax:617-244-9189
Practice Address - Street 1:1101 BEACON ST
Practice Address - Street 2:
Practice Address - City:NEWTON HIGHLANDS
Practice Address - State:MA
Practice Address - Zip Code:02461-1101
Practice Address - Country:US
Practice Address - Phone:617-332-6880
Practice Address - Fax:617-244-9189
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA27370183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist