Healthcare Provider Details

I. General information

NPI: 1174464291
Provider Name (Legal Business Name): DILLON PHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3240 ARDEN WAY
SACRAMENTO CA
95825-2015
US

IV. Provider business mailing address

3240 ARDEN WAY
SACRAMENTO CA
95825-2015
US

V. Phone/Fax

Practice location:
  • Phone: 408-930-5472
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number89717
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: