Healthcare Provider Details

I. General information

NPI: 1356755961
Provider Name (Legal Business Name): NHUNG PHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 06/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 ARUNDEL DR
HAYWARD CA
94542-7907
US

IV. Provider business mailing address

167 ARUNDEL DR
HAYWARD CA
94542-7907
US

V. Phone/Fax

Practice location:
  • Phone: 559-688-5839
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number70329
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: