Healthcare Provider Details

I. General information

NPI: 1376471011
Provider Name (Legal Business Name): KEVIN PHAM PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 BELMONT ST
WORCESTER MA
01605-2903
US

IV. Provider business mailing address

35 HARRINGTON AVE UNIT 4306
SHREWSBURY MA
01545-5286
US

V. Phone/Fax

Practice location:
  • Phone: 508-450-6466
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH240451
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: