MEDICARE: DUC NAM PHAM

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	PS32720	FL

General Provider Information

NPI Number	:	1083214001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUC NAM PHAM

Provider Business Mailing Address
First Line	:	4519 62ND AVE E
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34203-6305
Country	:	US
Telephone Number	:	941-545-4019
Fax Number	:

Provider Business Practice Location Address
First Line	:	5300 30TH ST E
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34203-8400
Country	:	US
Telephone Number	:	941-727-6896
Fax Number	:

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

Provider Enumeration Date	:	10/28/2020
Last Update Date	:	10/28/2020

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Directions to “ DUC NAM PHAM ” Practice Location

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