MEDICARE: JENNY T PHAM PHARM. D

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	55257	CA

General Provider Information

NPI Number	:	1225308828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNY T PHAM PHARM. D

Provider Business Mailing Address
First Line	:	5913 CARSON ST
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90713-3104
Country	:	US
Telephone Number	:	562-429-9120
Fax Number	:	562-429-8340

Provider Business Practice Location Address
First Line	:	5913 CARSON ST
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90713-3104
Country	:	US
Telephone Number	:	562-429-9120
Fax Number	:	562-429-8340

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

Provider Enumeration Date	:	01/12/2012
Last Update Date	:	01/12/2012

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