Provider Demographics
NPI:1649932732
Name:PHAM, DENISE V (PHARM D)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:V
Last Name:PHAM
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4933 FIESTA AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-3817
Mailing Address - Country:US
Mailing Address - Phone:626-374-4483
Mailing Address - Fax:310-320-3334
Practice Address - Street 1:1037 W CARSON ST
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2005
Practice Address - Country:US
Practice Address - Phone:310-320-3333
Practice Address - Fax:310-320-3334
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH58693183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist