Provider Demographics
NPI:1356950869
Name:PHAM, LOI (PHARMACIST)
Entity type:Individual
Prefix:
First Name:LOI
Middle Name:
Last Name:PHAM
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 INTERNATIONAL BLVD # 105
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-2993
Mailing Address - Country:US
Mailing Address - Phone:510-451-3234
Mailing Address - Fax:
Practice Address - Street 1:600 INTERNATIONAL BLVD # 105
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-2993
Practice Address - Country:US
Practice Address - Phone:510-451-3234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45477183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist