Healthcare Provider Details

I. General information

NPI: 1306511399
Provider Name (Legal Business Name): JESSICA PHAM PHARMD, BCACP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19841 N 27TH AVE STE 303
PHOENIX AZ
85027-4011
US

IV. Provider business mailing address

19841 N 27TH AVE STE 303
PHOENIX AZ
85027-4011
US

V. Phone/Fax

Practice location:
  • Phone: 480-583-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPS62927
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberPS62927
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberS027871
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS62927
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: