Healthcare Provider Details

I. General information

NPI: 1548524358
Provider Name (Legal Business Name): PHUONG PHAM PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 11/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4344 UNIVERSITY WAY NE
SEATTLE WA
98105-5809
US

IV. Provider business mailing address

4025 DELRIDGE WAY SW STE 400
SEATTLE WA
98106-1273
US

V. Phone/Fax

Practice location:
  • Phone: 206-632-3514
  • Fax:
Mailing address:
  • Phone: 206-763-2626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60343848
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: