Healthcare Provider Details

I. General information

NPI: 1669790952
Provider Name (Legal Business Name): DAVID Q PHAM PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2010
Last Update Date: 05/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 SUPERIOR AVE SUITE 150
NEWPORT BEACH CA
92663-3637
US

IV. Provider business mailing address

520 SUPERIOR AVE SUITE 150
NEWPORT BEACH CA
92663-3637
US

V. Phone/Fax

Practice location:
  • Phone: 949-764-8065
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number52964
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: