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NPI Code Detail

MEDICARE: LOAN NGOC PHAM PHARM D

MEDICARE: LOAN NGOC 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
1183500000XPharmacist46484CA

General Provider Information

NPI Number : 1306163456
Entity Type Code : Individual
Provider Name (Legal Business Name) : LOAN NGOC PHAM PHARM D
Provider Business Mailing Address
First Line : 1605 VALLEY FALLS AVE
Second Line :
City : REDLANDS
State : CA
Zip : 92374-2777
Country : US
Telephone Number : 909-794-2095
Fax Number :
Provider Business Practice Location Address
First Line : 1430 BEAUMONT AVE
Second Line :
City : BEAUMONT
State : CA
Zip : 92223-4704
Country : US
Telephone Number : 951-769-4095
Fax Number : 951-796-4096
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/29/2010
Last Update Date : 04/29/2010

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Directions to “ LOAN NGOC PHAM PHARM D” Practice Location

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