MEDICARE: HUYEN 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	PHA55548	CA

General Provider Information

NPI Number	:	1811323272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HUYEN PHAM PHARM. D

Provider Business Mailing Address
First Line	:	25201 LINDA VISTA DR
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-5358
Country	:	US
Telephone Number	:	949-293-5349
Fax Number	:

Provider Business Practice Location Address
First Line	:	25201 LINDA VISTA DR
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-5358
Country	:	US
Telephone Number	:	949-293-5349
Fax Number	:

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

Provider Enumeration Date	:	09/17/2013
Last Update Date	:	09/17/2013

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