Healthcare Provider Details

I. General information

NPI: 1548083223
Provider Name (Legal Business Name): MY HOANG UYEN PHAM PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2024
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 W CHELTEN AVE
PHILADELPHIA PA
19144-3380
US

IV. Provider business mailing address

164 W CHELTEN AVE
PHILADELPHIA PA
19144-3380
US

V. Phone/Fax

Practice location:
  • Phone: 215-438-5167
  • Fax:
Mailing address:
  • Phone: 215-438-5167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP458990
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: