Provider Demographics
NPI:1780991232
Name:PHAM, NGOCUYEN M (RPH)
Entity type:Individual
Prefix:MRS
First Name:NGOCUYEN
Middle Name:M
Last Name:PHAM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2726 GALLOWS RD APT 816
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-7149
Mailing Address - Country:US
Mailing Address - Phone:571-265-4377
Mailing Address - Fax:
Practice Address - Street 1:2260A HUNTERS WOODS PLZ
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-2898
Practice Address - Country:US
Practice Address - Phone:703-860-0300
Practice Address - Fax:703-860-6716
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-04
Last Update Date:2010-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202012979183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist