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General NPI Number Information
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NPI Number | 1053982876
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Entity Type | Individual
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Provider Name | DAT PHAM LE PHARMD
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Gender | Male
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Dates
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Enumeration Date | 07/02/2021
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Last Update Date | 07/02/2021
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Provider Practice Location Address
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Address Line | 150 MUIR RD
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City | MARTINEZ
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State | CA
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Zip | 94553-4668
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Country | US
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Telephone | 916-843-7304
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Fax |
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Provider Business Mailing Address
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Address Line | 129 DEODAR DR
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City | PACHECO
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State | CA
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Zip | 94553-5539
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Country | US
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Telephone | 714-757-5290
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Fax |
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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 | 84466
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License Number State | CA
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