Healthcare Provider Details

I. General information

NPI: 1134920325
Provider Name (Legal Business Name): JENNIFER HUYNH PHAM PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2025
Last Update Date: 03/22/2025
Certification Date: 03/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 E NIZHONI BLVD
GALLUP NM
87301-5748
US

IV. Provider business mailing address

220 E NIZHONI BLVD APT 5
GALLUP NM
87301-7110
US

V. Phone/Fax

Practice location:
  • Phone: 505-722-1185
  • Fax:
Mailing address:
  • Phone: 213-290-8797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0330135438
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: