Healthcare Provider Details

I. General information

NPI: 1114207735
Provider Name (Legal Business Name): PHUONG THI PHAM PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2011
Last Update Date: 08/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87109-1308
US

IV. Provider business mailing address

1856 SMARTY JONES ST SE
ALBUQUERQUE NM
87123-2397
US

V. Phone/Fax

Practice location:
  • Phone: 505-881-5210
  • Fax:
Mailing address:
  • Phone: 505-563-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00007671
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: