Healthcare Provider Details

I. General information

NPI: 1619802741
Provider Name (Legal Business Name): THUANANH THI PHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15663 BROOKHURST ST
WESTMINSTER CA
92683-7556
US

IV. Provider business mailing address

15663 BROOKHURST ST
WESTMINSTER CA
92683-7556
US

V. Phone/Fax

Practice location:
  • Phone: 714-839-1267
  • Fax: 714-839-5871
Mailing address:
  • Phone: 714-839-1267
  • Fax: 714-839-5871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number41328
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: