Healthcare Provider Details

I. General information

NPI: 1447580329
Provider Name (Legal Business Name): PHAM FAMILY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2009
Last Update Date: 10/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11722 MARSH LN STE 343
DALLAS TX
75229-2682
US

IV. Provider business mailing address

14902 PRESTON RD SUITE 404-513
DALLAS TX
75254-9191
US

V. Phone/Fax

Practice location:
  • Phone: 210-366-1212
  • Fax: 210-366-1217
Mailing address:
  • Phone: 214-888-8099
  • Fax: 214-261-2217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number26748
License Number StateTX

VIII. Authorized Official

Name: CARY ROSSEL
Title or Position: OFFICER
Credential:
Phone: 214-888-8099