MEDICARE: ASHLEY MAI PHAM R.PH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	38267	TX

General Provider Information

NPI Number	:	1023649704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY MAI PHAM R.PH

Provider Business Mailing Address
First Line	:	5308 DESERT FALLS DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-4931
Country	:	US
Telephone Number	:	972-979-4121
Fax Number	:

Provider Business Practice Location Address
First Line	:	976 KELLER PKWY
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76248-3608
Country	:	US
Telephone Number	:	817-431-5178
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2020
Last Update Date	:	01/30/2020

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