MEDICARE: CATHERINE 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	72410	CA

General Provider Information

NPI Number	:	1306204953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE PHAM

Provider Business Mailing Address
First Line	:	678 PERINO LN
Second Line	:
City	:	TRACY
State	:	CA
Zip	:	95376-2471
Country	:	US
Telephone Number	:	714-932-7992
Fax Number	:

Provider Business Practice Location Address
First Line	:	14840 HIGHWAY 4
Second Line	:
City	:	DISCOVERY BAY
State	:	CA
Zip	:	94505-2236
Country	:	US
Telephone Number	:	925-626-6011
Fax Number	:

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

Provider Enumeration Date	:	02/10/2016
Last Update Date	:	04/11/2017

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Directions to “ CATHERINE PHAM ” Practice Location

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