Healthcare Provider Details

I. General information

NPI: 1831760149
Provider Name (Legal Business Name): TINA HUYNH-PHAM PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 S SCHEUBER RD
CENTRALIA WA
98531-9027
US

IV. Provider business mailing address

219 PINEHURST DR SW APT 102
TUMWATER WA
98501-5278
US

V. Phone/Fax

Practice location:
  • Phone: 360-736-2803
  • Fax:
Mailing address:
  • Phone: 541-784-6526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH61071636
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: