MEDICARE: SIDNEY PHAM RPH

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	71360	CA

General Provider Information

NPI Number	:	1528432341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIDNEY PHAM RPH

Provider Business Mailing Address
First Line	:	610 W TEFFT ST
Second Line	:
City	:	NIPOMO
State	:	CA
Zip	:	93444-9187
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	610 W TEFFT ST
Second Line	:
City	:	NIPOMO
State	:	CA
Zip	:	93444-9187
Country	:	US
Telephone Number	:	805-929-2740
Fax Number	:	805-929-3360

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

Provider Enumeration Date	:	11/17/2015
Last Update Date	:	11/17/2015

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Directions to “ SIDNEY PHAM RPH” Practice Location

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