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General NPI Number Information
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NPI Number | 1558860460
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Entity Type | Individual
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Provider Name | MICHELLE TRANG PHAM RPH
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Gender | Female
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Dates
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Enumeration Date | 02/06/2018
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Last Update Date | 02/06/2018
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Provider Practice Location Address
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Address Line | 9650 BASELINE RD
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91701-5035
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Country | US
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Telephone | 909-987-3518
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Fax |
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Provider Business Mailing Address
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Address Line | 235 S BEACH BLVD SPC 105
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City | ANAHEIM
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State | CA
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Zip | 92804-1824
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Country | US
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Telephone | 714-251-8350
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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 | 78039
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License Number State | CA
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