Healthcare Provider Details

I. General information

NPI: 1558746339
Provider Name (Legal Business Name): PHONG TRINH RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2015
Last Update Date: 04/28/2023
Certification Date: 04/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11825 LOMAS BLVD NE
ALBUQUERQUE NM
87112-5613
US

IV. Provider business mailing address

11905 LEAH CT NE
ALBUQUERQUE NM
87112-3544
US

V. Phone/Fax

Practice location:
  • Phone: 505-293-9156
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00008391
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: