MEDICARE: DR. PHUONG PHAM PHARM. D

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	PS36086	FL

General Provider Information

NPI Number	:	1669741823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHUONG PHAM PHARM. D

Provider Business Mailing Address
First Line	:	5185 NORTH LN
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32808-2088
Country	:	US
Telephone Number	:	407-298-6970
Fax Number	:	407-521-1197

Provider Business Practice Location Address
First Line	:	5185 NORTH LN
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32808-2088
Country	:	US
Telephone Number	:	407-298-6970
Fax Number	:	407-521-1197

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

Provider Enumeration Date	:	12/17/2011
Last Update Date	:	12/17/2011

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