Healthcare Provider Details

I. General information

NPI: 1477942928
Provider Name (Legal Business Name): TANYA THANH-NHAN PHAM RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2015
Last Update Date: 01/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 CRESTON RD
PASO ROBLES CA
93446-3031
US

IV. Provider business mailing address

5217 W 2ND ST
SANTA ANA CA
92703-3012
US

V. Phone/Fax

Practice location:
  • Phone: 805-239-3028
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number72200
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: