MEDICARE: MISS LY HUONG NGOC 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	17745	LA

General Provider Information

NPI Number	:	1891870945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LY HUONG NGOC PHAM PHARM.D

Provider Business Mailing Address
First Line	:	12500 OLD HAMMOND HWY
Second Line	:	UNIT D-1
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-1088
Country	:	US
Telephone Number	:	225-246-8287
Fax Number	:

Provider Business Practice Location Address
First Line	:	13555 OLD HAMMOND HWY
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-1161
Country	:	US
Telephone Number	:	225-272-8566
Fax Number	:	225-272-6005

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

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	07/08/2007

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