Healthcare Provider Details

I. General information

NPI: 1396237525
Provider Name (Legal Business Name): CHRISTINE NGOC PHAM PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2018
Last Update Date: 08/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4224 E SHIELDS AVE
FRESNO CA
93726
US

IV. Provider business mailing address

8662 MARYLEE DR
GARDEN GROVE CA
92841-2220
US

V. Phone/Fax

Practice location:
  • Phone: 559-229-6024
  • Fax: 559-229-8093
Mailing address:
  • Phone: 714-583-9522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number78437
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: