MEDICARE: QUYEN NGOC 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	31272	TX

General Provider Information

NPI Number	:	1306441993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QUYEN NGOC PHAM

Provider Business Mailing Address
First Line	:	959 BAY AREA BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-2603
Country	:	US
Telephone Number	:	281-212-8041
Fax Number	:	281-212-8046

Provider Business Practice Location Address
First Line	:	959 BAY AREA BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-2603
Country	:	US
Telephone Number	:	281-212-8041
Fax Number	:	281-212-8046

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

Provider Enumeration Date	:	12/01/2020
Last Update Date	:	09/22/2022

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Directions to “ QUYEN NGOC PHAM ” Practice Location

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