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General NPI Number Information
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NPI Number | 1215204060
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Entity Type | Individual
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Provider Name | ANDY M PHAM PHARM. D.
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Gender | Male
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Dates
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Enumeration Date | 11/22/2011
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Last Update Date | 11/22/2011
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Provider Practice Location Address
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Address Line | 2011 N RIVERSIDE AVE
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City | RIALTO
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State | CA
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Zip | 92377-4601
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Country | US
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Telephone | 909-820-9230
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Fax |
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Provider Business Mailing Address
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Address Line | 2525 E MAVERICK AVE
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City | ANAHEIM
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State | CA
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Zip | 92806-5046
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Country | US
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Telephone | 714-600-3695
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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 | 58788
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License Number State | CA
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