Provider Demographics
NPI:1720389729
Name:PHAM, THOMAS THONG (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:THONG
Last Name:PHAM
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11033 VAN UFFELEN DR
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-6523
Mailing Address - Country:US
Mailing Address - Phone:909-799-1432
Mailing Address - Fax:
Practice Address - Street 1:2025 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-4704
Practice Address - Country:US
Practice Address - Phone:909-824-8299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-06
Last Update Date:2010-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51090183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist