Provider Demographics
NPI:1912283185
Name:PHAM, CHI P (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHI
Middle Name:P
Last Name:PHAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 MAIN ST
Mailing Address - Street 2:APT 401
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4957
Mailing Address - Country:US
Mailing Address - Phone:857-221-2408
Mailing Address - Fax:
Practice Address - Street 1:281 MAIN ST
Practice Address - Street 2:APT 401
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4957
Practice Address - Country:US
Practice Address - Phone:857-221-2408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR5763183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist