Healthcare Provider Details

I. General information

NPI: 1255110839
Provider Name (Legal Business Name): TRANG PHAM PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 YAKIMA AVE STE 20
TACOMA WA
98405-5307
US

IV. Provider business mailing address

1719 S 243RD ST
DES MOINES WA
98198-8636
US

V. Phone/Fax

Practice location:
  • Phone: 253-426-4727
  • Fax: 253-426-4895
Mailing address:
  • Phone: 425-770-6332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberPH61428300
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: