Healthcare Provider Details

I. General information

NPI: 1043135197
Provider Name (Legal Business Name): QUYNH PHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 ROUND ROCK AVE STE 150
ROUND ROCK TX
78681-4019
US

IV. Provider business mailing address

4815 HARMON AVE UNIT A
AUSTIN TX
78751-3420
US

V. Phone/Fax

Practice location:
  • Phone: 512-687-0368
  • Fax:
Mailing address:
  • Phone: 512-687-0368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number37466
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: