Healthcare Provider Details

I. General information

NPI: 1508141136
Provider Name (Legal Business Name): DAT DUC PHAM PHARMD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DOUG PHAM PHARMD.

II. Dates (important events)

Enumeration Date: 10/14/2011
Last Update Date: 04/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BREWSTER BLVD NAVAL HOSPITAL
CAMP LEJEUNE NC
28547-2538
US

IV. Provider business mailing address

155 MARLENE DR
JACKSONVILLE NC
28546-7540
US

V. Phone/Fax

Practice location:
  • Phone: 910-450-4172
  • Fax:
Mailing address:
  • Phone: 704-763-9204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21593
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: