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NPI Code Detail

MEDICARE: MR. KEVIN ANH PHAM RPH

MEDICARE: MR. KEVIN ANH 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
1183500000XPharmacistS011232AZ

General Provider Information

NPI Number : 1811216302
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KEVIN ANH PHAM RPH
Provider Business Mailing Address
First Line : 14097 W ROANOKE AVE
Second Line :
City : GOODYEAR
State : AZ
Zip : 85395-2480
Country : US
Telephone Number : 623-236-8669
Fax Number : 623-236-8669
Provider Business Practice Location Address
First Line : 2626 S 83RD AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85043-2125
Country : US
Telephone Number : 623-907-2472
Fax Number : 623-907-2472
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2010
Last Update Date : 09/09/2014

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