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General NPI Number Information
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NPI Number | 1053698720
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Entity Type | Individual
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Provider Name | JOHN DUC PHAM PHARM D.
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Gender | Male
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Dates
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Enumeration Date | 11/09/2011
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Last Update Date | 11/10/2011
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Provider Practice Location Address
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Address Line | 200 WESTMINSTER MALL T2304
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City | WESTMINSTER
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State | CA
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Zip | 92683-4984
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Country | US
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Telephone | 714-657-1352
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Fax | 714-657-1362
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Provider Business Mailing Address
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Address Line | 200 WESTMINSTER MALL T2304
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City | WESTMINSTER
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State | CA
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Zip | 92683-4984
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Country | US
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Telephone | 714-657-1352
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Fax | 714-657-1362
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 57509
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License Number State | CA
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