MEDICARE: DR. THOMAS THONG PHAM PHARM. D

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	51090	CA

General Provider Information

NPI Number	:	1720389729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS THONG PHAM PHARM. D

Provider Business Mailing Address
First Line	:	11033 VAN UFFELEN DR
Second Line	:
City	:	LOMA LINDA
State	:	CA
Zip	:	92354-6523
Country	:	US
Telephone Number	:	909-799-1432
Fax Number	:

Provider Business Practice Location Address
First Line	:	2025 E WASHINGTON ST
Second Line	:
City	:	COLTON
State	:	CA
Zip	:	92324-4704
Country	:	US
Telephone Number	:	909-824-8299
Fax Number	:

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

Provider Enumeration Date	:	11/06/2010
Last Update Date	:	11/06/2010

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