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General NPI Number Information
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NPI Number | 1073858619
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Entity Type | Individual
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Provider Name | KHOA PHAM PHARM. D.
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Gender | Male
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Dates
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Enumeration Date | 12/09/2012
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Last Update Date | 12/09/2012
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Provider Practice Location Address
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Address Line | 5545 CYPRESS GARDENS BLVD
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City | WINTER HAVEN
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State | FL
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Zip | 33884-2243
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Country | US
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Telephone | 863-318-8686
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Fax |
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Provider Business Mailing Address
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Address Line | 7036 CROOKED LAKE TRL
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City | ORLANDO
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State | FL
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Zip | 32818-8308
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Country | US
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Telephone | 407-437-5752
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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 | PS49491
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License Number State | FL
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