Healthcare Provider Details

I. General information

NPI: 1942875703
Provider Name (Legal Business Name): CYNTHIA THAI PHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2544 CAMPBELL PL STE 150
CARLSBAD CA
92009-1768
US

IV. Provider business mailing address

4748 68TH ST APT A
SAN DIEGO CA
92115-3094
US

V. Phone/Fax

Practice location:
  • Phone: 800-730-9887
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number83130
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: