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General NPI Number Information
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NPI Number | 1376824771
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Entity Type | Individual
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Provider Name | THI ANH PHAM PHARMACIST
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Gender | Male
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Dates
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Enumeration Date | 08/30/2011
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Last Update Date | 08/30/2011
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Provider Practice Location Address
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Address Line | 609 KINGSLEY AVE
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City | ORANGE PARK
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State | FL
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Zip | 32073-5443
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Country | US
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Telephone | 904-213-8083
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Fax | 904-213-8796
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Provider Business Mailing Address
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Address Line | 609 KINGSLEY AVE
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City | ORANGE PARK
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State | FL
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Zip | 32073-5443
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Country | US
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Telephone | 904-213-8083
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Fax | 904-213-8796
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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 | PS38511
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License Number State | FL
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