MEDICARE: ALEX TOAN 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	183700000X	Pharmacy Technician

General Provider Information

NPI Number	:	1497421952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEX TOAN PHAM

Provider Business Mailing Address
First Line	:	5517 NE 9TH ST
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98059-4630
Country	:	US
Telephone Number	:	253-285-2705
Fax Number	:

Provider Business Practice Location Address
First Line	:	3023 78TH AVE SE
Second Line	:
City	:	MERCER ISLAND
State	:	WA
Zip	:	98040-2822
Country	:	US
Telephone Number	:	206-236-0776
Fax Number	:

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

Provider Enumeration Date	:	08/16/2021
Last Update Date	:	01/10/2022

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Directions to “ ALEX TOAN PHAM ” Practice Location

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