Provider Demographics
NPI:1649795709
Name:PHAM, MAI-KHOI (PHARMD)
Entity type:Individual
Prefix:
First Name:MAI-KHOI
Middle Name:
Last Name:PHAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:VU
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1816 N PECKHAM CIR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67230-1787
Mailing Address - Country:US
Mailing Address - Phone:316-516-6421
Mailing Address - Fax:
Practice Address - Street 1:225 E CLOUD AVE
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:KS
Practice Address - Zip Code:67002-8824
Practice Address - Country:US
Practice Address - Phone:316-733-3725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-102894183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist