MEDICARE: LAN 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	S015355	AZ

General Provider Information

NPI Number	:	1659789519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAN PHAM

Provider Business Mailing Address
First Line	:	1015 E RAY RD
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85225-1599
Country	:	US
Telephone Number	:	480-917-3041
Fax Number	:

Provider Business Practice Location Address
First Line	:	1015 E RAY RD
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85225-1599
Country	:	US
Telephone Number	:	480-917-3041
Fax Number	:

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

Provider Enumeration Date	:	07/23/2014
Last Update Date	:	07/23/2014

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Directions to “ LAN PHAM ” Practice Location

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