Provider Demographics
NPI:1952130999
Name:PHAM, BRENDEN TY (PHARMD)
Entity type:Individual
Prefix:
First Name:BRENDEN
Middle Name:TY
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:MAIL STOP: 04002/34K
Mailing Address - Street 2:3800 SE 22ND AVE
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202
Mailing Address - Country:US
Mailing Address - Phone:503-797-3845
Mailing Address - Fax:877-302-0310
Practice Address - Street 1:7411 NE 117TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-4706
Practice Address - Country:US
Practice Address - Phone:360-896-3533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0020179183500000X
WAPH-61600926183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist