MEDICARE: DR. LUAN DINH PHAM PHARMD

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	PS55146	FL

General Provider Information

NPI Number	:	1689108748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUAN DINH PHAM PHARMD

Provider Business Mailing Address
First Line	:	5050 WESLEY RD STE 110
Second Line	:
City	:	APOPKA
State	:	FL
Zip	:	32712-5908
Country	:	US
Telephone Number	:	866-943-4535
Fax Number	:	407-789-1479

Provider Business Practice Location Address
First Line	:	454 PARK AVE
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33403-2602
Country	:	US
Telephone Number	:	561-685-3530
Fax Number	:

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

Provider Enumeration Date	:	04/16/2017
Last Update Date	:	04/29/2025

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