Healthcare Provider Details

I. General information

NPI: 1407177231
Provider Name (Legal Business Name): JOANNE H. PHAM RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 06/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7859 FIRESTONE BLVD
DOWNEY CA
90241-4220
US

IV. Provider business mailing address

16654 MOUNT BAXTER CIR
FOUNTAIN VALLEY CA
92708-2431
US

V. Phone/Fax

Practice location:
  • Phone: 562-869-8890
  • Fax: 562-861-5418
Mailing address:
  • Phone: 714-531-5372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number45639
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: