Healthcare Provider Details

I. General information

NPI: 1558681411
Provider Name (Legal Business Name): KRISTINE DOAN PHAM PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2010
Last Update Date: 06/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7860 GERBER RD
SACRAMENTO CA
95828-4302
US

IV. Provider business mailing address

7860 GERBER RD
SACRAMENTO CA
95828-4302
US

V. Phone/Fax

Practice location:
  • Phone: 916-689-8578
  • Fax:
Mailing address:
  • Phone: 916-689-8578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number52985
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: