Healthcare Provider Details

I. General information

NPI: 1548817109
Provider Name (Legal Business Name): THANH VU MINH PHAM PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 11/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 N BROAD ST
PHILADELPHIA PA
19122-1105
US

IV. Provider business mailing address

6255 N 4TH ST
PHILADELPHIA PA
19120-1403
US

V. Phone/Fax

Practice location:
  • Phone: 215-236-2297
  • Fax: 215-236-7216
Mailing address:
  • Phone: 267-437-9621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP453802
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: