Healthcare Provider Details

I. General information

NPI: 1164973822
Provider Name (Legal Business Name): TRACY PHAM PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2016
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 PACIFIC AVE # A
LONG BEACH CA
90813-1715
US

IV. Provider business mailing address

7302 ROCKMONT AVE
WESTMINSTER CA
92683-6125
US

V. Phone/Fax

Practice location:
  • Phone: 562-599-5292
  • Fax: 562-599-1893
Mailing address:
  • Phone: 714-548-8551
  • Fax: 562-599-5292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number59107
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: