Healthcare Provider Details

I. General information

NPI: 1164053708
Provider Name (Legal Business Name): PHAM CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2020
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 E MAIN ST
TUSTIN CA
92780-4408
US

IV. Provider business mailing address

160 E MAIN ST
TUSTIN CA
92780-4408
US

V. Phone/Fax

Practice location:
  • Phone: 714-760-4615
  • Fax: 714-475-1606
Mailing address:
  • Phone: 877-760-4615
  • Fax: 714-475-1606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARY PHAM
Title or Position: CEO
Credential: PHARM.D
Phone: 714-760-4615