Healthcare Provider Details

I. General information

NPI: 1518317908
Provider Name (Legal Business Name): KIM D PHAM R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIM PHAM NGUYEN R.PH.

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 GARRETT RD
UPPER DARBY PA
19082-3106
US

IV. Provider business mailing address

140 GARRETT RD
UPPER DARBY PA
19082-3106
US

V. Phone/Fax

Practice location:
  • Phone: 610-352-2477
  • Fax: 610-352-3911
Mailing address:
  • Phone: 610-352-2477
  • Fax: 610-352-3911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP033704L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: