Healthcare Provider Details

I. General information

NPI: 1831022367
Provider Name (Legal Business Name): THAO T PHAM PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5026 W US 52
NEW PALESTINE IN
46163-9770
US

IV. Provider business mailing address

915 S MERIDIAN ST APT 634
INDIANAPOLIS IN
46225-1318
US

V. Phone/Fax

Practice location:
  • Phone: 317-861-4838
  • Fax:
Mailing address:
  • Phone: 857-919-7862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26031914A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: