MEDICARE: NGOC T PHAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	18991	MD

General Provider Information

NPI Number	:	1124303102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NGOC T PHAM

Provider Business Mailing Address
First Line	:	3136 RIVER VALLEY CHASE
Second Line	:
City	:	WEST FRIENDSHIP
State	:	MD
Zip	:	21794-9542
Country	:	US
Telephone Number	:	410-489-4638
Fax Number	:

Provider Business Practice Location Address
First Line	:	5740 RITCHIE HWY
Second Line	:
City	:	BROOKLYN
State	:	MD
Zip	:	21225-3641
Country	:	US
Telephone Number	:	410-789-2127
Fax Number	:	410-789-1827

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2011
Last Update Date	:	10/20/2011

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Directions to “ NGOC T PHAM ” Practice Location

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