MEDICARE: MR. GIAO K 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	50405	CA

General Provider Information

NPI Number	:	1285953646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GIAO K PHAM RPH

Provider Business Mailing Address
First Line	:	19564 SHADOW GLEN CIR
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91326-3828
Country	:	US
Telephone Number	:	818-926-0329
Fax Number	:

Provider Business Practice Location Address
First Line	:	8400 VAN NUYS BLVD
Second Line	:
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-3610
Country	:	US
Telephone Number	:	818-891-6785
Fax Number	:

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

Provider Enumeration Date	:	05/25/2010
Last Update Date	:	05/25/2010

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