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General NPI Number Information
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NPI Number | 1225774474
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Entity Type | Individual
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Provider Name | CHRISTINE DA-THAO PHAM RPH
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Gender | Female
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Dates
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Enumeration Date | 05/10/2022
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Last Update Date | 10/22/2024
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Provider Practice Location Address
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Address Line | 12555 NW CORNELL RD
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City | PORTLAND
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State | OR
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Zip | 97229-5683
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Country | US
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Telephone | 503-495-4157
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Fax | 971-266-2950
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Provider Business Mailing Address
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Address Line | 203 PHARMACY BLDG
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City | CORVALLIS
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State | OR
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Zip | 97331-8537
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Country | US
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Telephone | 541-737-3424
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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 | PH61602902
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | PI-0013899
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH-0020192
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License Number State | OR
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