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General NPI Number Information
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NPI Number | 1548801251
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Entity Type | Individual
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Provider Name | THEODORE PHAM NGUYEN PHARMD, BCPS
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Gender | Male
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Dates
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Enumeration Date | 10/03/2019
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Last Update Date | 12/14/2021
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Provider Practice Location Address
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Address Line | 529 MAPLE AVE
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City | LOS ANGELES
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State | CA
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Zip | 90013-1511
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Country | US
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Telephone | 213-629-6200
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Fax |
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Provider Business Mailing Address
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Address Line | 510 S VERMONT AVE # 21-097
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City | LOS ANGELES
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State | CA
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Zip | 90020-1992
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Country | US
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Telephone | 714-767-1878
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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 | 23666
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 786789
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 786789
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 786789
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License Number State | CA
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