MEDICARE: PHAM T DO DPH

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	11841	OK

General Provider Information

NPI Number	:	1538256219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHAM T DO DPH

Provider Business Mailing Address
First Line	:	2908 TWIN LAKE DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73165-7351
Country	:	US
Telephone Number	:	405-378-2904
Fax Number	:

Provider Business Practice Location Address
First Line	:	2908 TWIN LAKE DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73165-7351
Country	:	US
Telephone Number	:	405-378-2904
Fax Number	:

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

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	07/08/2007

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Directions to “ PHAM T DO DPH” Practice Location

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