MEDICARE: THAI PHAM RPH

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	183500000X	Pharmacist	03-1-20917	OH

General Provider Information

NPI Number	:	1053472456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THAI PHAM RPH

Provider Business Mailing Address
First Line	:	6137 GLENWORTH CT
Second Line	:
City	:	GALLOWAY
State	:	OH
Zip	:	43119-8559
Country	:	US
Telephone Number	:	614-206-9879
Fax Number	:	614-358-6500

Provider Business Practice Location Address
First Line	:	5690 W BROAD ST
Second Line	:
City	:	GALLOWAY
State	:	OH
Zip	:	43119-8127
Country	:	US
Telephone Number	:	614-870-7816
Fax Number	:

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

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	06/13/2024

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