MEDICARE: CANH PHAM RPH

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	048900	NY

General Provider Information

NPI Number	:	1578733879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANH PHAM RPH

Provider Business Mailing Address
First Line	:	155 ISLIP AVE
Second Line	:
City	:	ISLIP
State	:	NY
Zip	:	11751-3210
Country	:	US
Telephone Number	:	631-581-1510
Fax Number	:	631-224-4312

Provider Business Practice Location Address
First Line	:	155 ISLIP AVE
Second Line	:
City	:	ISLIP
State	:	NY
Zip	:	11751-3210
Country	:	US
Telephone Number	:	631-581-1510
Fax Number	:	631-224-4312

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

Provider Enumeration Date	:	03/03/2008
Last Update Date	:	03/03/2008

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Directions to “ CANH PHAM RPH” Practice Location

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