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General NPI Number Information
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NPI Number | 1952130999
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Entity Type | Individual
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Provider Name | BRENDEN TY PHAM PHARMD
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Gender | Female
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Dates
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Enumeration Date | 07/29/2024
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Last Update Date | 09/18/2024
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Provider Practice Location Address
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Address Line | 7411 NE 117TH AVE
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City | VANCOUVER
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State | WA
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Zip | 98662-4706
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Country | US
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Telephone | 360-896-3533
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Fax |
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Provider Business Mailing Address
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Address Line | MAIL STOP: 04002/34K 3800 SE 22ND AVE
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City | PORTLAND
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State | OR
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Zip | 97202
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Country | US
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Telephone | 503-797-3845
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Fax | 877-302-0310
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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 | RPH-0020179
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License Number State | OR
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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 | PH-61600926
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License Number State | WA
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