Provider Demographics
NPI:1669585998
Name:PHAM, PHUONG B (RPH)
Entity type:Individual
Prefix:MS
First Name:PHUONG
Middle Name:B
Last Name:PHAM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1501 CHASEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-3305
Mailing Address - Country:US
Mailing Address - Phone:512-246-2121
Mailing Address - Fax:512-246-2995
Practice Address - Street 1:2251 DOUBLE CREEK DR
Practice Address - Street 2:STE 402
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-3830
Practice Address - Country:US
Practice Address - Phone:512-246-2121
Practice Address - Fax:512-246-2995
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34129183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist