Healthcare Provider Details

I. General information

NPI: 1457944340
Provider Name (Legal Business Name): JUSTINE PHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2021
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12666 BROOKHURST ST STE 110
GARDEN GROVE CA
92840-4866
US

IV. Provider business mailing address

12666 BROOKHURST ST STE 110
GARDEN GROVE CA
92840-4866
US

V. Phone/Fax

Practice location:
  • Phone: 714-705-6992
  • Fax:
Mailing address:
  • Phone: 714-705-6992
  • Fax: 714-591-0591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number80773
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: