Healthcare Provider Details

I. General information

NPI: 1407845969
Provider Name (Legal Business Name): TRAM PHAM PHARMD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 08/31/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15735 HAWTHORNE BLVD #110
LAWNDALE CA
90260
US

IV. Provider business mailing address

15735 HAWTHORNE BLVD #110
LAWNDALE CA
90260
US

V. Phone/Fax

Practice location:
  • Phone: 310-676-3489
  • Fax: 310-676-7929
Mailing address:
  • Phone: 310-676-3489
  • Fax: 310-676-7929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHY40535
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHA 405350
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TRAM PHAM
Title or Position: OWNER
Credential:
Phone: 310-676-3489