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General NPI Number Information
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NPI Number | 1821503723
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Entity Type | Individual
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Provider Name | QUANG BENJAMIN THAI PHAM PHARMD
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Gender | Male
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Dates
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Enumeration Date | 12/13/2017
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Last Update Date | 12/13/2017
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Provider Practice Location Address
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Address Line | 904 S RANGE AVE
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City | DENHAM SPRINGS
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State | LA
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Zip | 70726-4802
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Country | US
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Telephone | 225-665-3237
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Fax |
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Provider Business Mailing Address
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Address Line | 4851 GILBERT ST
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City | NEW ORLEANS
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State | LA
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Zip | 70129-1612
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Country | US
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Telephone |
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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 | PST.022257
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License Number State | LA
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